Analysis of causes of graft loss in 135 kidney transplant recipients / 南方医科大学学报

OBJECTIVE@#To investigate the causes of graft loss in kidney transplant recipients.@*METHODS@#We retrospectively analyzed the clinical data of 135 recipients with graft loss after renal transplantation in the Eighth Medical Center of Chinese PLA General Hospital from January 1, 2002 to January 1, 2022.@*RESULTS@#A total of 135 kidney transplant recipients experienced graft failure. The causes of graft loss included graft rejection (70 cases, 51.8%), death of the recipients with functional graft (37 cases, 27.4%), surgical complications (12 cases, 8.9%), drug toxicity (4 cases, 3.0%), carbapenem-resistant Klebsiella pneumoniae infection (4 cases, 3.0%), polyoma BK virus-related nephropathy (3 cases, 2.2%), primary nonfunctioning kidney (2 cases, 1.5%), recurrence of primary disease (2 cases, 1.5%), and prerenal acute renal failure (1 case, 0.7%).@*CONCLUSION@#The main cause of graft loss after renal transplantation is graft rejection, and the secondary cause is death of the recipient with functional graft, and other reasons can be rare.

Alelos HLA más comunes y asociados con riesgo o protección en enfermedad renal crónica de etiología no determinada / Most common HLA alleles associated with risk or protection in chronic kidney disease of undetermined etiology

Resumen Introducción: La enfermedad renal crónica representa parte del gasto en salud en general; una potencial etiología es la relacionada con variaciones, ausencia o presencia de algunos alelos del human leucocyte antigen (HLA). Método: Se realizó el análisis de 1965 reportes de HLA sin etiología determinada y de 1361 donadores renales. Se llevó a cabo tecnología Luminex con base en fluorimetría de flujo celular para los locus A, B, DRB1 y DQA. Se realizó análisis con tablas de contingencia para determinar razón de momios (RM) e intervalos de confianza (IC). Se efectuó análisis cuantitativo. Resultados: De 101 alelos encontrados, 13 presentaron asociación, siete con riesgo para enfermedad renal crónica, de los cuales el más significativo fue HLA-DR17, con RM = 3.91 (IC 95 % = 2.96-5.17), y el de mayor significación de protección fue HLA-DR9, con RM = 0.043 (IC 95 % = 0.005-0.3224). Conclusiones: Es necesario entender que las enfermedades renales pueden estar ligadas a procesos inmunológicos, en los que se tiene que conocer la asociación de la ausencia o presencia de algún alelo.

Abstract Introduction: Chronic kidney disease accounts for part of overall health expenditure; a potential etiology is related to variations, absence or presence of some human leukocyte antigen (HLA) alleles. Method: An analysis of HLA reports of 1965 kidney recipients with no determined etiology, and 1361 kidney donors was performed. It was carried out with Luminex based in cell flow fluorometry for the A, B, DRB1 and DQA loci. An analysis was performed with contingency tables in order to determine the odds ratio (OR) and confidence intervals (CI). Quantitative analysis was also carried out. Results: Of the 101 alleles found, 13 showed association, 7 with risk for chronic kidney disease, with the most significant being HLA-DR17 with an OR of 3.91 (95 % CI = 2.96-5.17) and the one with the highest significance for protection being HLA-DR9, with an OR of 0.043 (95 % CI = 0.005-0.3224). Conclusions: It is necessary to understand that kidney diseases can be associated with yet unknown immune processes, where the association of the absence or presence of any allele should be known.

Psychosocial Adjustment in Families with Kidney Donor or Recipient / 간호학회지

The purpose of this study was to generated a grounded theory of how families with kidney donor or recipient copel with kidney transplantations. Interview data from twelve familes involved in didney transplants was analyzed using the grounded theory method. Data analysis revealed that "protecting the family" was the main theme that represented family member experiences. In order to maintain family function and to protect the family from breaking up, family members had to adjust the family structure from the traditional style of a husband-centered family, to one that was patient health-centered. the process of this adjustment was a very long and difficult one, taking several years from the recognition of the kidney disease to the kidney transplants. Family members, especially spouses, employed nine different strategies to deal with various problems and conflicts which occurred during the process : 1) paying attention to the patient's illness and complications ; 2) accepting the patients's illness as the family's illness as well ; 3) managing the patient's illness and complications that occurred ; 4) being thrifty ; 5) supporting the kidney donor ; 6) accepting and replacing the lost roles of the patient ; 7) keeping composure and encouraging the patient ; 8) sustaining the patient's independence ; 9) self-restraining sexual desires.