RESUMEN
In this study, we compare cholesterol levels during the first year after renal transplantation in FK506 (Prograf)- and cyclosporine-treated patients matched for cumulative first-year steroid dose and hypercholesterolemia risk factors. All patients had pretransplant cholesterol levels < 200 mg/dl. At 3 months posttransplant, 68% of the cyclosporine-treated patients had at least one cholesterol level greater than 200 mg/dl compared with 30% of the FK506-treated patients (P < 0.05). At the end of the year, 26% of FK506- and 67% of cyclosporine-treated patients remained hypercholesterolemic (P < 0.05). We conclude that cyclosporine has inherently more effect on cholesterol levels than FK506 during the first year after kidney transplantation.
Asunto(s)
Ciclosporina/efectos adversos , Hipercolesterolemia/epidemiología , Inmunosupresores/efectos adversos , Trasplante de Riñón/inmunología , Complicaciones Posoperatorias/epidemiología , Tacrolimus/efectos adversos , Adulto , Factores de Edad , Colesterol/sangre , Diabetes Mellitus Tipo 1/epidemiología , Femenino , Furosemida/uso terapéutico , Humanos , Hipercolesterolemia/inducido químicamente , Incidencia , Trasplante de Riñón/fisiología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/inducido químicamente , Estudios Retrospectivos , Factores SexualesRESUMEN
BACKGROUND: As the number of patients on the United States kidney transplant list increases, investigation into the utility of transplanting organs formerly considered marginal or undesirable has intensified. Using kidneys from hepatitis B surface antigen (HBsAg)-positive donors is thought to place recipients at excessive risk of graft failure, morbidity, and mortality. However, the risks of using kidneys from HBsAg-negative but hepatitis B core antibody (HBcAb)-positive donors have not been defined. METHODS: Between 1990 and 1994, our group transplanted 1067 cadaveric kidneys, including 38 from HBsAg(-)/HBcAb(+) donors. Of these 38 kidneys, 27 were transplanted into HBcAb(-) recipients (group 1) and 11 were transplanted into HBcAb(+) recipients (group 2). Group 1 and 2 patients received no hepatitis immunoglobulin therapy after transplantation and received the same immunosuppression and rejection therapies as recipients of kidneys from HBcAb(-) donors. RESULTS: After transplantation, none of the group 1 patients became HBsAg(+), three became hepatitis B surface antibody (HBsAb)-positive, and two became HBcAb(+). Of the group 2 patients, none became newly HBsAg(+) or HBsAb(+). No patient receiving a kidney from an HBsAg(-)/HBcAb(+) donor developed signs or symptoms of clinical hepatitis B. Graft and patient survival rates were similar in both groups and similar to the rates of the 1029 recipients of kidneys from HBcAb(-) donors. CONCLUSIONS: Recipients of kidneys from HBsAg(-)/HBcAb(+) donors are at a small risk of hepatitis B seroconversion but are at no excess risk of graft failure or short-term morbidity or mortality.
Asunto(s)
Anticuerpos contra la Hepatitis B/análisis , Antígenos del Núcleo de la Hepatitis B/inmunología , Antígenos de Superficie de la Hepatitis B/análisis , Trasplante de Riñón/inmunología , Trasplante de Riñón/normas , Adulto , Cadáver , Femenino , Humanos , Donadores Vivos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Donantes de Tejidos/estadística & datos numéricos , Obtención de Tejidos y Órganos/métodosRESUMEN
BACKGROUND: The optimal use of very young cadaveric kidneys (from donors less than 4 years old) remains controversial. High rates of technical complications and poor functional results compared with adult donor kidneys have been reported. The use of en bloc transplantation to overcome these problems has been advocated, although en bloc transplantation halves the number of potential transplants from very young donors. METHODS: We studied the technical and functional results of 91 transplants from very young donors performed at our institution between 1984 and 1995. This included 59 single and 22 en bloc procedures involving first transplants and 7 single and 3 en bloc procedures involving retransplantation. Individual surgeon preference dictated the use of either the single or en bloc technique. Kidneys smaller than 6 cm tended to be transplanted en bloc, and lighter patients were generally given preference for receiving pediatric kidneys. Patients received sequential cyclosporine-based quadruple immunosuppression. RESULTS: En bloc kidneys had a 1-year and 5-year graft survival of 82% and 70%, respectively. Single kidneys had a 1-year and 5-year graft survival of 64% and 40%. Kidneys that avoided acute rejection episodes and that were transplanted into heavier or male recipients had better long-term survival. Kidneys from donors less than 2 years old did poorly whether transplanted en bloc or singly. Better HLA matching improved short-term, but not long-term, graft survival, whereas cold ischemic time did not have statistically significant association with differences in graft survival. Eleven percent of the transplants had ureteral leaks, but only one kidney was lost. Ten transplants had vascular complications leading to graft loss, whereas two episodes of arterial stenosis were successfully treated with percutaneous angioplasty. CONCLUSIONS: En bloc transplantation optimizes the outcome of transplantation with very young kidneys. We recommend induction therapy and cyclosporine immunosuppression with cyclosporine levels similar to adult target levels to minimize rejection episodes and, thus, improve outcome. These kidneys should be distributed nationally, because better HLA matching is associated with improved short-term graft survival. Our high ureteral leak rate indicates that alternatives to unstented ureteroneocystostomy should be considered.
Asunto(s)
Trasplante de Riñón/métodos , Adulto , Cadáver , Preescolar , Supervivencia de Injerto/fisiología , Humanos , Trasplante de Riñón/inmunología , Trasplante de Riñón/fisiología , Tromboflebitis/etiología , Factores de Tiempo , Donantes de Tejidos , Resultado del Tratamiento , Uréter/trasplanteAsunto(s)
Supervivencia de Injerto/fisiología , Prueba de Histocompatibilidad , Trasplante de Riñón/fisiología , Preservación de Órganos , Obtención de Tejidos y Órganos/organización & administración , Adolescente , Adulto , Cadáver , Niño , Frío , Femenino , Supervivencia de Injerto/inmunología , Antígenos HLA-A , Antígenos HLA-B , Antígenos HLA-DR , Humanos , Terapia de Inmunosupresión/métodos , Isquemia , Trasplante de Riñón/inmunología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Tiempo , Donantes de TejidosAsunto(s)
Hepacivirus , Anticuerpos Antihepatitis/sangre , Hepatitis C/diagnóstico , Trasplante de Riñón/fisiología , Adulto , Transfusión Sanguínea , Femenino , Estudios de Seguimiento , Hepatitis C/epidemiología , Hepatitis C/transmisión , Anticuerpos contra la Hepatitis C , Humanos , Inmunosupresores/uso terapéutico , Pruebas de Función Hepática , Masculino , Prevalencia , Estudios Prospectivos , Factores de Tiempo , Donantes de TejidosAsunto(s)
Supervivencia de Injerto , Trasplante de Riñón/fisiología , Preservación de Órganos/métodos , Frío , Prueba de Histocompatibilidad , Humanos , Isquemia , Pruebas de Función Renal , Trasplante de Riñón/inmunología , Trasplante de Riñón/métodos , Estudios Retrospectivos , Factores de Tiempo , Trasplante HomólogoAsunto(s)
Rechazo de Injerto/inmunología , Supervivencia de Injerto/inmunología , Antígenos de Histocompatibilidad Clase II/inmunología , Trasplante de Riñón/inmunología , Complejo Mayor de Histocompatibilidad/inmunología , Complicaciones Posoperatorias/inmunología , Conservación de Tejido , Cadáver , Estudios de Seguimiento , Rechazo de Injerto/mortalidad , Antígenos HLA-DR/inmunología , Humanos , Trasplante de Riñón/mortalidad , Complicaciones Posoperatorias/mortalidad , Tasa de Supervivencia , Factores de TiempoAsunto(s)
Ciclosporinas/uso terapéutico , Supervivencia de Injerto , Prueba de Histocompatibilidad , Trasplante de Riñón/inmunología , Esteroides/uso terapéutico , Donantes de Tejidos , Adulto , Familia , Femenino , Rechazo de Injerto , Antígenos HLA , Humanos , Trasplante de Riñón/fisiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Esteroides/efectos adversos , Resultado del TratamientoRESUMEN
Crossed nonfused renal ectopia is a rare congenital renal anomaly. Two kidneys were recovered from a 45-year-old cadaver donor with this anomaly and transplanted successfully. Complex renal anomalies should not prevent the use of such kidneys in cadaver renal transplantation.