ABO-incompatible living-donor pediatric kidney transplantation in Japan

The Japanese ABO-Incompatible Transplantation Committee officially collected and analyzed data on pediatric ABO-incompatible living-donor kidney transplantation in July 2012. The age of a child was defined as <16 years, and 89 children who had undergone ABO-incompatible living-donor kidney transplantation from 1989 to 2011 were entered in a registry. These data were presented as the Japanese registry of pediatric ABO-incompatible living-donor kidney transplantation at the regional meetings of the International Pediatric Transplantation Association (IPTA) in Nagoya in September 2012 and in Sao Paulo in November 2012.

Programa de Transplante Hepático Infantil do Hospital de Clínicas de Porto Alegre: resultados dos doze primeiros transplantes hepáticos intervivos / Pediatric liver transplantation program: results of living liver transplantation

Introdução: O Hospital de Clínicas de Porto Alegre (HCPA) é pioneiro na realização de transplante hepático infantil (THI) no RS. A menor oferta de doadores falecidos tem estimulado a realização de transplante hepático (TxH) intervivos. Objetivo: Descrever os resultados do THI intervivos do programa THI-HCPA. Método: Estudo descritivo. Incluídos: receptores de TxH intervivos, 18 anos, ambos os sexos e respectivos doadores, voluntários, ambos os sexos. Excluídos: insufi ciência hepática aguda. Variáveis: receptores: características clínico-demográficas, antropométricas; sorologias para Citomegalovírus (CMV) e Epstein-Barr (EBV); incidência de complicações pós-operatórias, tempo de internação, sobrevida 12 meses; doadores: características clínico-demográficas, sobrevida 12 meses. Todas as cirurgias foram realizadas pelo mesmo cirurgião e os dados, coletados prospectivamente. Estudo aprovado pelo Comitê de Ética em Pesquisa do HCPA (13-0208). Resultados: Doze TxH intervivos incluídos. Idade dos receptores: mediana=2 anos (sexo feminino:7). Espera em lista: 141,4±10,3d. Indicação de TxH: 83,3% atresia biliar. IMC normal: 100%. Child- -Pugh: C:7/12(58%). PELD: mediana=11,9a. Pré-TxH:IgG+CMV (10); IgG+EBV(4); ascite (7); peritonite bacteriana espontânea (3), hiponatremia dilucional (7); encefalopatia hepática (2); varizes esofágicas (4); hemorragia digestiva alta (3). Idade dos doadores: 31,8±8,4a. Sexo feminino=50%; 92% aparentado. Pesos receptor/doador: 19,2±8,9%. Implante do segmento hepático lateral esquerdo: 100%. Tempo de isquemia total: 1,34±0,67h. Duração da cirurgia: 5,94±2,58h. Duração da internação (receptores): 30,6 ± 25,2d. Complicações receptores: vascular (4), biliar (3), steal syndrome (1), small for size (2), sepse (1). Reintervenções cirúrgicas: 5. Tempo de permanência em UTI: mediana=9d. Primo-infecção: CMV (1), EBV (3). Rejeição celular aguda (4). Sobrevida em 1 ano: 76,7%. Tempo de internação(doadores): 8,1±4,0 d. Complicações ao doador: dor pós-operatória (80%). Conclusão: Os nossos resultados se assemelham àqueles da literatura no que se refere à incidência de complicações. A cirurgia tem se mostrado segura para o doador (AU)

Introduction: Hospital de Clínicas de Porto Alegre (HCPA) is a pioneer in conducting child liver transplantation (CLT) in RS. The lower supply of deceased donors has stimulated living liver transplant (LTx). Aim: To describe the results of living CLT in the THI-HCPA program. Methods: A descriptive study that included: LTx recipients from living donor, ≤ 18 years old, both sexes and their donors, volunteers, both sexes; and excluded: acute liver failure. Variables: Receptors: clinical, demographic and anthropometric characteristics, serology for cytomegalovirus (CMV) and Epstein-Barr virus (EBV) infection, incidence of postoperative complications, length of stay, 12-month survival; Donors: demographic and clinical characteristics, 12-month survival. All surgeries were performed by the same surgeon and the data were collected prospectively. This study was approved by the Research Ethics Committee of the HCPA (13-0208). Results: Twelve LTx from living donors were included. Age of recipients: median = 2 years (female: 7). Waiting in list: 141.4 ± 10.3 d. Indication for liver transplantation: 83.3% biliary atresia. Normal BMI: 100%. Child-Pugh C:7/12 (58%). PELD: median = 11.9a. Pre-LTx: CMV+IgG (10), EBV+IgG (4), ascites (7), spontaneous bacterial peritonitis (3), dilutional hyponatremia (7), hepatic encephalopathy (2), esophageal varices (4), high gastrointestinal bleeding (3). Donor age: 31.8 ± 8.4. Female = 50%, 92% related. Receiver/giver weights: 19.2 ± 8.9%. Implantation of left lateral hepatic segment: 100%. Total ischemic time: 1.34 ± 0.67 h. Length of surgery: 5.94 ± 2.58 h. Duration of hospitalization (receivers): 30.6 ± 25.2 d. Complications in receptors: vascular (4), bile (3), steal syndrome (1), small for size (2), sepsis (1). Surgical re-interventions: 5. Time in ICU: median = 9d. Primary infection: CMV (1), EBV (3). Acute cellular rejection (4). 1-year survival: 76.7%. Length of hospital stay (donors): 8.1 ± 4.0d. Donor complications: postoperative pain (80%). Conclusion: The results resemble those of the literature regarding the incidence of complications. The surgery has been shown to be safe for the donor (AU)

Isquemia fría prolongada, factor para rechazo agudo del injerto en trasplante renal cadavérico / Prolonged cold ischemia: risk factor for acute rejection in renal grafting of cadaveric kidney transplantation

Introducción: Es conocido que la exposición del injerto renal a tiempo prolongado de isquemia fría se asocia con rechazo agudo. Dado que no se encontró evidencia del tema en México, el objetivo de este estudio fue determinar el papel del tiempo de isquemia fría prolongado sobre el injerto en el trasplante renal cadavérico en población mexicana. Material y métodos: Estudio observacional, retrospectivo, transversal y analítico para el que se seleccionaron los expedientes de pacientes con trasplante renal entre julio de 1994 y junio de 2004. Se realizó análisis de diferentes variables para determinar su efecto sobre el rechazo agudo, entre ellas el tiempo prolongado de isquemia fría (≥ 12 horas). Resultados: De los 425 transplantes realizados, 33 fueron de donador cadavérico; 10 pacientes tuvieron rechazo agudo. El tiempo prolongado de isquemia fría (OR = 8.4, IC = 1.5-44.2, p = 0.02) y la combinación azatioprina (AZA)-prednisona (PDN)- ciclosporina (CSA) (OR = 9.1, IC = 1.5-49.4, p = 0.02) fueron factores de riesgo para rechazo agudo. El uso de antiCD25 (OR = 0.6, IC = 0.009-0.37, p = 0.001) y la combinación mofetil micofenolato (MMF)-PDN-CSA (OR = 0.1, IC = 0.02-0.65, p = 0.02) fueron factores protectores de rechazo agudo. Conclusiones: En una población mexicana, el tiempo de isquemia fría prolongado y la combinación AZA-PDN-CSA fueron factores de riesgo para rechazo agudo, mientras que el uso de antiCD25 y la combinación MMF-PDN-CSA fueron protectores para rechazo agudo en trasplantes renales de donadores cadavéricos.

BACKGROUND: Exposure of renal grafting to prolonged cold ischemia time (CIT) and the association with acute rejection (AR) are known. However, there is no evidence in Mexico about this topic. Thus, the objective of this study was to evaluate prolonged CIT as a risk factor for AR in renal grafting of cadaveric kidney transplantation in a Mexican population. METHODS: A cross-sectional study was carried out. Clinical files of patients undergoing renal grafting using cadaveric kidneys were reviewed from July 1994-June 2004. Prolonged CIT (=12 h) as a risk factor for AR was evaluated. Other related variables were also examined. RESULTS: From 425 kidney transplantations, only 33 cases were cadaveric. Ten patients had AR. Prolonged CIT (OR 8.4; CI 1.5-44.2, p = 0.02) and azathioprine (AZA)-prednisone (PDN)-cyclosporine (CSA) combination (OR 9.1; CI 1.5-49.4, p = 0.02) were risk factors for AR. Anti-CD25 use (OR 0.6; CI 0.009-0.37, p = 0.001) and mycofenolate mofetil (MMF)-PDN-CSA combination (OR 0.1; CI 0.02-0.65, p = 0.02) were protective factors for AR. CONCLUSIONS: In a Mexican population, prolonged CIT and AZA-PDN-CSA combination were risk factors for AR. Meanwhile, anti- CD25 use and MMF-PDN-CSA combination were protective factors for AR in cadaveric kidney transplantations.

Recurrência da hepatite C após transplante hepático de doador vivo e falecido / Hepatitis C recurrence after living donor and cadaveric liver transplantation

OBJETIVO: Determinar a recurrência da hepatite C em pacientes submetidos a transplante hepático de doador vivo comparados com os submetidos a transplante hepático de doador falecido. MÉTODOS: Do total de 333 transplantes hepáticos, 279 (83,8 por cento) eram de doador falecido e 54 (16,2 por cento) de doador vivo. Hepatopatia crônica pelo vírus da hepatite C foi a indicação mais comum tanto de transplante hepático de doador falecido (82 pacientes) como de doador vivo (19 pacientes). O protocolo de estudo eletrônico de todos pacientes com hepatopatia crônica pelo vírus da hepatite C foi avaliado. Os dados coletados foram analisados estatisticamente conforme a idade, sexo, resultado dos exames laboratoriais, recidiva do vírus da hepatite C e rejeição aguda. RESULTADOS: O total de 55 transplantes hepáticos de doador falecido e 10 de doador vivo realizados em pacientes com cirrose hepática pelo vírus da hepatite C, foi incluído no estudo. As características clínicas e laboratoriais pré-transplante dos dois grupos foram similares, exceto o tempo de atividade de protrombina que foi maior no grupo de transplante hepático de doador falecido do que no de doador vivo (P = 0,04). A recidiva da hepatite C foi similar nos grupos de transplante hepático de doador falecido (n = 37; 69,3 por cento) e de doador vivo (n = 7; 70 por cento) (P = 0,8). A incidência de rejeição aguda foi igual no grupo de transplante hepático de doador falecido (n = 27; 49 por cento) e no grupo de doador vivo (n = 2; 20 por cento) (P = 0,08). A recurrência do vírus da hepatite C nos pacientes do grupo de transplante hepático de doador falecido que receberam pulsoterapia (9 de 11 pacientes) foi similar aos demais pacientes (28 de 44 pacientes) (P = 0,25). A recurrência também foi similar nos pacientes do grupo de transplante hepático de doador vivo que receberam pulsoterapia (1 de 1 paciente) em relação aos que não receberam (6 de 9 pacientes) (P = 0,7). CONCLUSÕES: A recurrência...

OBJECTIVE: To determine the recurrence of hepatitis C in patients subjected to living donor liver transplantation compared to those subjected to cadaveric liver transplantation. METHODS: Of a total of 333 liver transplantations, 279 (83.8 percent) were cadaveric liver transplantation and 54 (16.2 percent) living donor liver transplantation. Hepatic cirrhosis due to hepatitis C virus was the most common indication of both cadaveric liver transplantation (82 patients) and living donor liver transplantation (19 patients). The electronic study protocols of all patients with hepatic cirrhosis due to hepatitis C virus were reviewed. All data, including patients' age and sex, laboratory tests, hepatitis C virus recurrence and acute rejection were evaluated statistically. RESULTS: A total of 55 cadaveric liver transplantation and 10 living donor liver transplantation performed in patients with liver cirrhosis due to hepatitis C virus was included in the study. Clinical and laboratory characteristics of the two groups before the transplantation were similar, except for the prothrombin time that was higher for the cadaveric liver transplantation than the living donor liver transplantation (P = 0.04). Hepatitis C virus recurrence was similar in the cadaveric liver transplantation (n = 37; 69.3 percent) and living donor liver transplantation (n = 7; 70 percent) groups (P = 0.8). The incidence of acute rejection was similar in cadaveric liver transplantation (n = 27; 49 percent) and living donor liver transplantation (n = 2; 20 percent) groups (P = 0.08). Hepatitis C virus recurrence in patients of the cadaveric liver transplantation group who received bolus doses of corticosteroids (9 of 11 patients) was similar to the remained patients (28 of 44 patients) (P = 0.25). Recurrence was also similar in patients of the living donor liver transplantation group who received bolus doses of corticosteroids (one of one patient) in relation to those who did...

Nepalese kidney transplant recipient in a follow up clinic: related and unrelated living donor.

A cohort retrospective study was conducted on all follow up kidney transplant recipients at Transplant Follow up Clinic from June 16, 2003 to July 15, 2008. The main objective of this study was to find out the demographic pattern of the kidney transplant recipients and type of donors. Among 452 recipients, the transplantation were done in India (449), Germany (2) and in the USA (1) with male to female ratio of 3:1. Kidney donors were unrelated 315 (69.69%), related 134 (29.43%) and some did not disclose 4 (0.88%). Most of the kidney transplantation (93.75%) were done in 45 different hospitals in India and about three quarters (71.7%) of them were operated in the private hospitals in various states of India; only 2 (4.16%) in Germany and 1 (2.08%) in USA. Newar was the largest population 142 (31.4%) and second largest group was Mangol 124 (27.4.4%) that comprised of Gurung, Rai, Magar, Tamang etc. Brahmins were the third largest population 91 (20.1%). In this study the youngest recipients was 14 years and the oldest was of 75 years. The mean age was 41 (SD 13.84). This study showed that 35 (7.7%) died, 8 (1.7%) reported rejection and underwent re-transplantation and 238 patient have lost follow up till early 2008. Kidney transplantation should be promoted as it is cheaper compared to dialysis in the long run. This study found that unrelated kidney donors have outnumbered the related donors in Nepalese kidney transplant recipients which emphasize the importance of unambiguous documentation and also a provision of lawful action against the middle-men if found involved in an illegal kidney related activities in Nepal. Organ transplantation is an important integral part of human health and should be regularize and promote lawfully to protect humans from trafficking for kidney, possible kidnapping, killing and stealing.

Trasplante renal en pediatría / Renal transplantation in children

Despite being considered a high risk procedure, renal transplantation has been recognized for more than 20 years as the best therapeutic option for children with end-stage renal disease since it is superior than any available dialytic procedure in improving the neuropsychological development and the quality of life. Today pediatric patients have similar graft survival than adults, and 10 year-old children or less have better outcome than any other age group. These remarking results are due to the development of specialized pediatric transplant centers and research programs, improvement in the selection and preparation of donors and recipients, refinement of the surgical technique and the use of new immunossupressive drugs.

El trasplante pediátrico fue considerado durante mucho tiempo de alto riesgo, ya que la sobrevida del injerto no era tan buena como la reportada en pacientes adultos, aún así desde hace 20 años es el tratamiento óptimo para los niños urémicos porque mejora el desarrollo neurológico, psicológico y la calidad de vida en forma muy superior a los procedimientos dialíticos disponibles. Actualmente, gracias al desarrollo de centros de trasplante e investigación especializados en la atención pediátrica, a la mejoría en la preparación y selección de donadores y receptores, en la técnica quirúrgica y a nuevos esquemas inmunosupresores los pacientes pediátricos tienen una sobrevida del injerto similar a la reportada en adultos, de hecho los niños menores de 10 años han logrado tener la mejor sobrevida del trasplante renal de todos los grupos etáreos.

Pediatric kidney transplantation: Siriraj Hospital experience.

We reported six children with end stage renal disease (ESRD) who received kidney transplantation in our unit from 1996 to 2000. They were 5 boys and 1 girl and their mean age was 9.7 +/- 2.7 years (range 6.8 to 13.2). Etiologies of ESRD were congenital anomalies (3 patients), chronic glomerulonephritis (2 patients), and rapidly progressive glomerulonephritis (1 patient). Prior to the transplantation, chronic peritoneal dialysis was used in 5 patients, including one who had to switch to hemodialysis due to chronic exit site infection and 1 had preemptive kidney transplantation. All children received a kidney from living-related donors, 4 from their fathers, 1 from his mother, and 1 from his elder brother. Triple immunosuppressive drug therapy (prednisolone, azathioprine, and cyclosporine A) was initially given to all patients. Serum creatinine returned to normal within the first week in all patients and 4 patients were discharged home by the end of the second week post operation. Immediate complications included severe hypertension (all patients), ureteral leakage (2 patients), neutropenia (3 patients) and nephrotic syndrome (1 patient). Azathioprine was discontinued in 2 patients due to persistent neutropenia. Cyclosporine A was discontinued in 1 patient due to hepatotoxicity, this patient was maintained on mycophenolate mofetil and prednisolone. Serum creatinine levels at last follow-up (mean 24.3 +/- 19.0 months, range 8-55) were normal in 5 patients and slightly increased (1.5 mg/dl) in one. Five patients returned to school full time within 1 year after kidney transplantation. Height standard deviation score improved markedly as early as 6 months post transplant. The cost of maintenance of the immunosuppressive drugs was similar to adults, i.e. 6,859.1 +/- 1,151.8 Baht per month at 6 months post kidney transplantation. We concluded that kidney transplantation can be performed successfully in selected Thai children with very good results and similar cost of treatment as for adults.

Evaluation and selection of living related kidney donors--our experience in a government hospital.

In a state-funded, live related-donor kidney transplantation programme, 616 eligible end stage renal failure (ESRF) patients were seen over a four-year period. 73% of them had potential related donors, 64% of whom were willing to donate. Fear of surgery, non-congenial pre-morbid relationships and discouragement by family members were the most common reasons for unwillingness to donate. After investigations, 76% of the willing donors were found to be fit. ABO incompatibility, lymphocyte cross-match positivity and anatomic abnormalities were the most common grounds for non-acceptance. Sixty eight percent of the willing, fit donors finally donated their kidneys, patient-death and donor-recipient withdrawal before surgery accounting for the remaining. One hundred and forty eight patients underwent renal transplantation. Two-thirds of the donors were females, mothers (37%) forming the single largest group. Eight five percent of the recipients were males. Overall, only 35% of the eligible ESRF patients had related, willing and fit donors attesting to the need for an active, cadaver-donor transplantation programme.