Impact of age and gender matching on long-term graft function and actual graft survival in live-related renal transplantation: Retrospective study from Sindh Institute of Urology and transplantation, Pakistan.

In renal transplantation, donor and allograft age are known to have an important influence on the outcome of the graft, reflecting functional renal mass. We evaluated the impact of gender and age matching in living-donor renal transplantation on long-term graft survival and actual graft function over five years from the day of transplantation. We retrospectively analyzed 500 primary live-related donor renal transplants performed from August 2007 to December 2008 at Sindh Institute of Urology and Transplantation, Karachi, Pakistan. Donors and recipients were divided into two age groups [young (YD) and elderly (ER)] with 40 years as cutoff line. Four donor recipient groups according to age match and age mismatch: YD/YR - ED/ER - YD/ER - ED/YR and four groups according to donor-recipient gender combinations: male recipients of male donors (MR/MD)-female recipients of male donors (FR/MD)-female recipients of female donors (FR/FD)-male recipients of female donors MR/FD) were studied. Serum creatinine was used to assess graft function after transplantation. The Kaplan-Meier method with the log-rank test was used to assess actual graft survival at five years. Actual graft function of four study groups based on age difference had no statistically significant difference at five years (P = 0.094). Regarding the actual graft survival, the best results were seen in young donor to elderly recipient group as compared to all other age combination groups. At five-year post-transplant, MD/MR had significantly better graft function than MR/FD and FR/MD had significantly better graft function than FD/FR and FD/MR. The actual graft survival was best in male-to-male (86%) compared to the lowest in female-to-female transplants (75%). The graft function at five years was better in elderly recipients of young donor kidneys. The actual graft survival was influenced positively by young donor age and negatively influenced by pre-transplant hepatitis C positivity of recipients.

Evaluation of renal function by cystatin C in renal transplant recipients.

OBJECTIVES: We evaluated cystatin C concentration as a marker of glomerular filtration rate in renal transplant recipients, and its correlation with creatinine-based glomerular filtration rate by urinary creatinine clearance, and the Cockroft-Gault and Modification of Diet in Renal Disease formulas. MATERIALS AND METHODS: In this cross-sectional study, we measured serum cystatin C levels and its correlation with serum creatinine, creatinine clearance, and glomerular filtration rate using the Cockroft-Gault formula and Modification of Diet in Renal Disease formulas. RESULTS: One hundred two recipients between June and December 2012, were examined. The mean subject age was 31.87 ± 8.37 years; the male:female ratio was 4.3:1. Mean serum creatinine concentration was 141.44 ± 43.31 mol/L (1.60 ± 0.49 mg/dL) and serum cystatin C 122.09 ± 38.95 nmol/L (1.63 ± 0.52 mg/L). Serum cystatin C was significantly correlated with serum creatinine (r=0.90; P<.001), creatinine clearance (r=0.77; P<.001), and the Cockroft-Gault (r=0.73; P<.001) and the Modification of Diet in Renal Disease formulas (r=0.82; P<.001). We assessed the correlation among serum cystatin C with serum creatinine, creatinine clearance, the Cockroft-Gault and Modification of Diet in Renal Disease at 1, 2-3, 4-5, and more than 5 years after transplant. The correlation between serum cystatin C and serum creatinine ranged from 0.8 to 1.0; cystatin C and creatinine clearance ranged from 0.8 to 0.85; serum cystatin C and the Cockroft-Gault Formula ranged from 0.7 to 0.8; and serum cystatin C and the Modification of Diet in Renal Disease formulas ranged from 0.8 to 0.84. CONCLUSIONS: Our results show that serum cystatin C is a reliable marker for estimating glomerular filtration rate among renal transplant recipients. This test can determine the glomerular filtration rate of renal transplant recipients on follow-up. Further studies are required to establish serum cystatin C as a standard test for monitoring glomerular filtration rate in transplanted patients.

Frequency of urinary tract infection in renal transplant recipients and effect on graft function.

OBJECTIVE: To determine the risk factors of urinary tract infection in renal transplant recipients and its effect on graft function among transplanted patients visiting the outpatients department of Sindh Institute of Urology and Transplantation. METHODS: This cohort study was conducted at Transplantation department, Sindh Institute of Urology and Transplantation Karachi. The period of the study enrollment extended from April 2008 to September 2008 included were two hundred adult live related renal transplant recipients who were enrolled during the initial post transplant period and followed up for one year. Analysis was done by using SPSS ver 10.0. The level of significance was taken as 0.05. Student's t test and chi square test were used to compare the variables in both groups. RESULTS: The mean age of the patients was 30 +/- 10 years. Sixty six (33%) renal transplant recipients had at least one episode of urinary tract infection which occurred in 51 (77%) patients during the first two months after renal transplant and 8 (12%) patients had recurrence of infection. Gram negative bacilli were the principally isolated agents. E. coli was found in 34 (51%) patients and Pseudomonas in 12 (18%). Renal stone disease, structural abnormalities, delays in Foleys removal, and post operation hospital stay were statistically significant risk factors for urinary tract infection in the patients. Twenty three recipients of the study developed early graft dysfunction due to urinary tract infection. No graft was lost in either groups. CONCLUSION: Structural abnormalities, renal stone disease, delay in removal of Foley's catheter and increased post transplant hospital stay are risk factors leading to UTI in renal transplant recipients.