Kidney Transplantation Using Expanded-Criteria Deceased Donors: A Comparison With Ideal Deceased Donors and Non-Expanded-Criteria Deceased Donors.

PURPOSE: The use of expanded-criteria deceased-donor (ECD) kidneys must be evaluated within the objective perspective of critical organ shortage and graft function and survival. In this study, we aimed to compare the clinical outcomes of ECD reliance with concurrent use of ideal-criteria deceased donors (IDDs) and non-ECDs in adult renal transplantation. METHODS: Between February 2000 and December 2015, we analyzed 405 deceased-donor renal transplants, specifically 129 grafts (31.9%) from ECDs, 233 grafts (57.5%) from non-ECDs, and 43 grafts (10.6%) from IDDs. ECDs were classified according to the United Network for Organ Sharing guidelines, while an IDD was defined as a younger person (10-39 years of age) with no medical risk factors who died from a traumatic head injury. Donor and recipient risk factors were separately analyzed and correlated with recipient graft function, and survival was evaluated. RESULTS: ECDs were older (56.8 ± 6.3 years); showed increased incidence of hypertension, diabetes, and cerebrovascular brain death; and had a higher pre-retrieval serum creatinine level than the other groups. ECD kidney recipients were also older (50.6 ± 9.8 years), had a shorter waiting time (P = .031), and demonstrated a low frequency of re-transplantation (P = .028). Long-term renal function followed longitudinally was lower in ECD kidney recipients until five years after transplantation, while the glomerular filtration rate (GFR) level at 7 and 10 years did not differ significantly among the groups (P = .074 and .262, respectively). There were no significant differences in terms of graft survival (P = .394) or patient survival (P = .737) among the groups. CONCLUSIONS: Although the long-term renal function followed longitudinally was lower in ECD kidney recipients, the use of renal grafts from ECDs is an acceptable method to resolve the disparity of critical organ shortage. However, the classification of the high-risk group should be updated with consideration given to differences in regional characteristics.

Effect of Donor-Recipient Age Match in Expanded Criteria Deceased Donor Kidney Transplantation.

PURPOSE: Our objective was to investigate the effects of age on patient and graft survival in expanded criteria donor (ECD) renal transplantation. METHODS: Between February 2000 and December 2015, we analyzed 405 deceased donor renal transplants, including 128 grafts (31.9%) from ECDs. Based on recipient age and ECD criteria classification, the recipients were divided into four groups: Group I, non-ECD to recipient age <50 years; Group II, non-ECD to recipient age ≥50 years; Group III, ECD to recipient age <50 years; and Group IV, ECD to recipient age ≥50 years. RESULTS: Among the four groups, there were significant differences in baseline characteristics (age, body mass index [BMI], cause of end-stage renal disease [ESRD], number of kidney transplantations, and use of induction agent). The mean modification of diet in renal disease (MDRD) glomerular filtration rate (GFR) level at 1 month, 6 months, 1 year, 3 years, and 5 years after transplantation was significantly lower in patients with ECDs but MDRD GFR level at 7, 9, and 10 years did not differ significantly (P = .183, .041, and .388, respectively). There were no significant differences in graft survival (P = .400) and patient survival (P = .147). CONCLUSION: Our result shows that, regardless of recipient age, kidney transplants donated by deceased ECDs have similar graft and patient survival.

Impact of Pretransplant Panel-Reactive Antibody Level on Renal Graft Survival in Patients With a Negative Crossmatch and No Donor-Specific Antibody.

BACKGROUND: Patients with high panel-reactive antibody (PRA) levels before transplantation tend to remain on the waiting list longer when considering cadaveric donor transplantation and have worse outcomes than those with lower PRA levels. This study investigated the impact of the pretransplantation PRA level on rejection and graft survival after kidney transplantation in patients with a negative crossmatch (CXM(-)) and no donor-specific antibody (DSA(-)). METHODS: We retrospectively analyzed 513 recipients of kidney allograft treated from January 2009 to April 2013. Those who tested positive on crossmatching, had donor-specific antibodies, were ABO incompatible, or had no PRA level data were excluded (n = 130). The remaining patients were stratified into 3 groups according to their PRA levels: group I, PRA = 0 (314 [80.1%]); group II, PRA ≤50% (27 [7.2%]); and group III, PRA >50% (27 [7.2%]). Graft failure was defined as a return to dialysis, transplant nephrectomy, or death with a functioning kidney. RESULTS: The mean patient follow-up was 30.4 ± 4.6 months. The rejection rate was 20.1% (group I, 18.5% [n = 58] vs group II, 23.8% [n = 10] vs group III, 33.3% [n = 9] [P = .053]). The graft failure rate was 21.7% (group I, 6.4% [n = 20] vs group II. 7.1% [n = 3] vs group III, 7.4% [n = 7] [P = .792]), and the 3-year graft survival rates were 96.3, 92.4, and 92.5%, respectively (P = .851). CONCLUSIONS: The pretransplant PRA level was not significantly associated with graft survival in patients with CXM(-) and DSA(-). However, the rejection rate tended toward significance as the PRA level increased (P = .053).

Characteristics of Femoral Motor Neuropathies Induced After Kidney Transplantation: A Case Series.

BACKGROUND: Femoral motor neuropathy (FMN) induced after kidney transplantation (KT) can injure the patient and graft, and it sometimes can leave sequelae on gait. Nevertheless, the cause of FMN has not been determined. We assessed 5 cases of FMN in an attempt to determine the traits induced after KT. METHODS: Patient data about general characteristics, immunologic characteristics, operative findings, post-operative status, and FMN characteristics were assessed. A Bookwalter self-retaining retractor was used and quadruple immunosuppression was implemented in all cases. RESULTS: Five patients had FMN. Four of the 5 patients were women. The mean body mass index (BMI) was 20.38 ± 1.99 kg/m(2) prior to KT and 19.08 ± 1.98 kg/m(2) after KT. The mean graft-recipient weight ratio was 3.46 ± 0.99 g/kg. There was no case of psoas muscle abscess or hematoma. Motor function recovery was obtained 3 to 313 days after rehabilitation. Immediate graft function was favorable in all patients with no rejection or significant complications. CONCLUSIONS: FMN after KT may occur in patients with a lower BMI and higher graft-recipient weight ratio. This study was based on only 5 patients, and therefore further studies with a larger population size are necessary.

Bio-lnspired dielectric elastomer actuator with AgNWs coated on carbon black electrode.

Bio-inspired dielectric elastomer actuators with AgNW-coated carbon black electrodes were developed in this study. The novel elastomer actuators show large in-plane deformations by electrical stimulation through the both electrodes. When a certain input voltage is applied to the elastomer electrode, the electrostatic force between cathode and anode electrodes compress the dielectric elastomer film, resulting large in in-plane direction deformation. The expanded area of the circular actuation device under 70 mV/m electric field was measured up to 50% due to a synergistic effect of highly conductive AgNW network and ultrahigh capacitance of carbon black electrodes.

The improvement of total organic carbon forecasting using neural networks discharge model.

It is advantageous to take simultaneous measurements of discharge and water quality at the same station for real-time management of water quality. However, some of the continuous water quality monitoring stations can be located some distance from the water level stations; and the case of the Pyeongchang River is one such in South Korea. The major monitoring parameter in water quality is total organic carbon. In this study, an artificial neural network model was constructed for discharge prediction at the continuous water quality monitoring station. This model was connected to another model that forecasts total organic carbon. The connected system showed better results than the single model in the forecasting of total organic carbon.

Application of artificial intelligence models in water quality forecasting.

The real-time data of the continuous water quality monitoring station at the Pyeongchang river was analyzed separately during the rainy period and non-rainy period. Total organic carbon data observed during the rainy period showed a greater mean value, maximum value and standard deviation than the data observed during the non-rainy period. Dissolved oxygen values during the rainy period were lower than those observed during the non-rainy period. It was analyzed that the discharge due to rain fall from the basin affects the change of the water quality. A model for the forecasting of water quality was constructed and applied using the neural network model and the adaptive neuro-fuzzy inference system. Regarding the models of levenberg-marquardt neural network, modular neural network and adaptive neuro-fuzzy inference system, all three models showed good results for the simulation of total organic carbon. The levenberg-marquardt neural network and modular neural network models showed better results than the adaptive neuro-fuzzy inference system model in the forecasting of dissolved oxygen. The modular neural network model, which was applied with the qualitative data of time in addition to quantitative data, showed the least error.