The sum of kidney donor profile index and estimated post-transplant survival scale and their correlation with egfr decline in deceased donor kidney recipients

Background: The impact of donor quality on post-kidney transplant survival may vary by candidate condition. Objective: Analyzing the combined use of the Kidney Donor Profile Index (KDPI) and the estimated post-transplant survival (EPTS) scale and their correlation with the estimated glomerular filtration rate (eGFR) decline in deceased-donor kidney recipients (DDKR). Methods: This was a retrospective, observational cohort study. We included DDKRs between 2015 and 2017 at a national third-level hospital. Results: We analyzed 68 DDKR. The mean age at transplant was 41 ± 14 years, 47 (69%) had sensitization events, 18 (26%) had delayed graft function, and 16 (23%) acute rejection. The graft survival at 12 and 36 months was 98.1% (95% CI 94-100) and 83.7% (95% CI 65-100), respectively. The Pearson correlation coefficient between the percentage reduction in the annual eGFR and the sum of EPTS and KDPI scales was r = 0.61, p < 0.001. The correlation coefficient between the percentage reduction in the annual eGFR and the EPTS and KDPI scales separately was r = 0.55, p < 0.001, and r = 0.53, p < 0.001, respectively. Conclusions: The sum of EPTS and KDPI scales can provide a better donor-recipient relationship and has a moderately positive correlation with the decrease in eGFR in DDKR.

De-novo anti-DQ antibodies as a risk factor for kidney allograft failure / Эрүүл мэндийн лаборатори

Background@#De-novo donor and non-donor specific antibodies could be detrimental to the kidney allograft. Kidney transplantation has being performed in Mongolia since 2006. However there is currently no published data available on post-transplant de-novo antibodies and long-term graft survival. Our aim was to determine immunosuppressive drug through level, its combination, de-novo HLA antibodies and its influence on graft survival in different immunosuppressive protocols. @*Methods@#We analyzed data from 56 adult first kidney transplant recipients at our hospital from August 2006 to May 2013. We determined the level of tacrolimus, cyclosporine A, and the presence of pre and post-transplant anti-HLA antibodies.@*Results@#Post-transplant follow up period was 1-8 years. Mean recipient age on transplantation was 33.9±9.1 years. Male 45 (80.4%). Cadaver donor kidney was 5 (8.9%). Mean donor age on transplantation was 39.98±11.13 years. Rejection occurrence was 12(21.4%). Tacrolimus and cyclosporine A through levels were 3-12.8ng/ml and 65- 324ng/ml respectively. Anti-HLA class I antibodies were detected in 17.9% of pretransplantation (n=10) and in 23.2% of post-transplantation (n=13) cases respectively (p=0.607). On the other hand, anti-HLA class II antibodies were detected in 5.4% of pretransplantation (n=3) and in 33.9% of post-transplantation (n=19) cases (p=0,001). We determined anti-HLA class II antibody specificity. Anti-DQ, DR, DP antibodies were 25% ( n=14), 14.3% ( n=8) and 7.1% ( n=4) respectively on all 56 cases. Two (3.6%) patients’ samples were positive on three loci of HLA class II. Six patient samples (10.7%) were positive on two loci. Nine (64.3%) of anti-DQ positive patients have rejected their grafts and begun hemodialysis treatment. All 9 graft rejected recipients were anti-HLA DQ positive and had taken cyclosporine mono-therapy for the first year after transplantation.@*Conclusion@#The presence of de-novo anti-HLA class II antibodies, especially de-novo anti-DQ were significantly increased on cyclosporine mono-therapy group following transplantation and negatively affected kidney graft survival. The blood through level of cyclosporine was very variable. The graft survival was better in standard triple regimen. Therefore, it is essential to monitor immunosuppressive drug combinations with drug blood level and anti-DSA antibodies as well as to manage antibody removal therapies such as therapeutic plasma exchange, intravenous immunoglobulin and Rituximab therapy on time. HLA –DQ-DP antigen determination is important for the kidney transplantation.

Impact of HLA-A-B-DR matching in kidney transplantation: Graft and patient survival in 5-year experiences / Эрүүл мэндийн лаборатори

Background@#Kidney transplantation has being performed in Mongolia since 2006. However there is currently no published data available on long-term graft and patient survival. @*Objective@#Our aim was to assess the long-term graft and patient survival rate correlation with HLA-A-B-DR matching.@*Methods@#We retrospectively analyzed data from 70 adult kidney transplants performed at our hospital from August 2006 through January 2014. The data was retrospectively collected from patient files, including characteristics of the recipient and donor, post transplant features and HLA-A-B-DR DNA based typing results. The Kaplan-Meier method was used to analyze graft and patient survival. @*Results@#The mean patient follow-up period after kidney transplantation was 39,6±25.9 months, and the mean kidney graft follow-up period was 36.6±23.7 months for 70 cases. Overall graft and patient survivals were 52 (74.3%) and 60 (85.7%) respectively in 70 cases. Five-year graft and patient survivals were 23 (67.6%) and 29 (85.3%) respectively in 34 cases. The group with four to six mismatched were found to have a significantly lower 3 and 5-year graft and patient survival (71%; 35%); (80%; 40%) compared to 0 to 1 mismatched group (100%) (p=.030; p=.015). Furthermore we analyzed the association of HLA matching, immunosuppressive therapy and long-term graft survival. We selected CNI mono-therapy group for long-term survival analysis and observed a similar pattern. In mono-therapy group, the group with four to six mismatched were found to have a significantly lower 3 and 5-year graft and patient survival (75%; 30%); (65%; 30%) compared to 0 to 1 mismatched group (100%) (p=.037; p=.001). @*Conclusion@#The results showed that graft and patient survival rates were lower compared with results from established centers. Statistically highly significant effect of HLA matching on kidney graft and patient survival rates was found in our analysis. Five years after transplantation the graft survival rate of first adult kidney transplant with 4-6MM was 65-70% lower than that of grafts with 0-1MM. Longitudinal cohort study needed in the future to exhibit an improved transplantation outcome.

Report of 1,500 Kidney Transplants at the Catholic University of Korea / 대한이식학회지

Purpose: The present study aims to determine the clinical outcome of kidney transplantation and to provide data of long-term graft and patient survival. Methods: Between 1969 and 2005, 1,500 kidney transplants were performed at the Kangnam st. Mary's hospital. We analyzed the clinical characteristics and outcomes of kidney transplant recipients retrospectively. Results: The mean follow-up period was 112 months. Chronic glomerulonephritis was the leading cause of primary renal diseases, but the proportion of has increased from 1 % before 1985 to 6% afterwards. First renal transplantation was 94.5% (n=1418), and retransplantation was 5.4% (n=82). Type of donor source was mostly living-related, with the recent decrease in the number of living- unrelated donors. Currently, 72l patients are alive with functioning grafts, 297 cases had graft failure, 277 cases died, 205 cases were transferred or lost during follow-up. Main cause of graft failure was chronic allograft nephropathy (n=316). Overall, 1-, 5-, 10-, and 20-year graft survival were 92%, 81%, 66%, and 29% respectively. 1-, 5-, 10-, and 20-year patient survival were 93%, 88%, 81%, and 69% respectively. Conclusion: This review of 36-years experience in a single center showed that the graft survival has improved compared to the initial transplantation era.

Clinical Analysis on 200 Cases of Kidney Transplantation in a Single Center / 대한이식학회지

PURPOSE: To determine the risk factors relating renal allograft and patient survival, we, Dae Jeon St. Mary's Hospital transplantaion team, Dae Jeon, Korea, reviewed 200 cases of kidney transplantation. METHODS: 200 medical records of kidney transplantation from February 1988 to June 2000 was reviewed retrospectively. The clinical follow up period was February 2001, and clinical analysis was done. RESULTS: 1) The original renal disease of the cases were 78 cases of chronic glomerulonephritis, 18 cases of diabetic nephropathy, 16 cases of hypertensive nephrosclerosis and 1 case of lupus nephritis, 2) The recipient-donor relationships were 14 cases of parent to offspring, 9 cases of offspring to parents, 26 cases of between siblings. There were 150 cases of non- related donor and 1 case of cadaveric donor, 3) At the end of Feb. 2001, 33 graft and 10 patients were lost (5 year graft survival was 88.3% and 5 year patient survival rate was 94.6%), 4) 7 cases of malignant tumors, 171 cases of hypertension, 141 cases of hyperlipdemia, 76 cases of Cushing's disease and 58 cases of hyperuricemia were developed, 5) There were 114 cases of infections (41 cases of bacterial infections, 40 cases of viral infections, 13 cases of tuberculosis and 20 cases of fungal infections), 6) The cases of surgical complications were 16 cases of lymphocele, 9 cases of urinary leakage, 5 cases of hematome and other 3 cases, 7) The factor analysis for graft survival showed that the donor and recipient age, number of acute rejection episodes had statistical significance. CONCLUSION: Episodes of acute rejection and old age group both in donor and recipient over 50 were the risk factors affecting renal allograft survival.