Kidney transplantation with Belzer or Custodiol solution: a randomized prospective study.

PURPOSE: The purpose of this study was to compare the Belzer vs Custodiol solutions for cadaveric kidney perfusion in relation to delayed graft function, renal function, acute rejection episodes, and patient and graft survivals. METHODS: This randomized prospective study included 42 kidneys and 9 simultaneous kidney and pancreas recipients from December 2002 to February 2004, namely 24 in the Custodiol arm and 27 in the Belzer arm. We analyzed delayed graft function frequency, acute rejection episodes (biopsy proven), renal function (creatinine at 1, 6, and 12 months), as well as graft and patient survivals. Categorical and continuous variables were evaluated as appropriate. RESULTS: We failed to observe a difference in the immunosuppressant drug protocol, cold ischemia time, or mean recipient or donor age. The prevalence of delayed graft function was 63% among the Belzer arm, and 50% among the Custodiol arm (P = NS). The renal function was the same in both arms at 1, 6, and 12 months. The graft survival after 3 months was 94% among the Belzer group (death from sepsis), and 95% among the Custodiol group (nonfunctioning graft). At 1 year, the results were 78% among the Belzer group (4 deaths from cardiovascular or infectious complications and 2 graft losses), and 79% among the Custodiol group (3 deaths, 1 primary nonfunctioning graft, and 1 graft loss; P = NS). After 12 months follow-up, patient survival was 84% among the Belzer group, and 86% among the Custodiol group. In the first year, the incidences of biopsy-proven acute rejection episodes were 37% among the Belzer group, and 33% among the Custodiol group. CONCLUSION: Custodiol solution achieved similar results compared with Belzer solution.

Parasitic infection in renal transplant recipients.

The purpose of this study was to evaluate the prevalence of symptomatic parasitic infections in adult renal transplant recipients. We retrospectively analyzed a sample of 657 adult renal transplant recipients performed from January 2001 to December 2005 for immunosuppression protocol, clinical manifestations, parasite diagnosis, treatments, and outcomes. The prevalence of symptomatic parasitosis infections was 2.4% (16/657). None of the infected patients received cyclosporine in their immunosuppression protocol. Most of the infections were caused by Strongyloids stercoralis (n = 11), followed by Giardia lamblia (n = 3), Toxoplasma gondii (n = 1), and Trypanosoma cruzi: (n = 1). Strongyloides stercoralis was the most frequent agent, causing three cases of hyperinfection including one fatal case. With the new immunosuppressive regimes there must be a suspicion of parasitic infection to avoid the diagnostic delay that can be fatal. Strategies, including empiric treatment for S. stercoralis, must be considered.

Expanding criteria for the use of living donors: what are the limits?

The cadaver organ shortage has pushed the transplant community to extend the boundaries beyond the traditional criteria used for living donor transplantation. This new liberal policy involves: (1) the type of donor, such as emotionally related individuals, the direct or indirect interchange of donors, anonymous as well as rewarded donation; (2) challenging immunological criteria, using incompatible ABO blood types and or transplantation across a positive cross-match; (3) relaxing clinical criteria related to elderly, hypertensive, or obese donors, or patients with nephrolithiasis, fibromuscular renal artery disease, hematuria, or renal cell carcinomas. However, these practices may be dangerous. They must be clearly validated to promote a liberal policy of donor acceptance since it may carry a risk for both the donor and the recipient as well as for society. It is crucial to ensure the physical integrity of the donor as well as to provide guarantees, for instance a 1-year policy of life insurance, an indefinite long-term medical follow-up and the assurance of going to the top of the waiting list if the donor becomes uremic in the future.

Pregnancy outcome after renal transplantation.

AIMS: The aim of our study was to evaluate the frequency and the outcome of pregnancies in renal transplant recipients at our center. METHODS: This study involved the retrospective analysis of 405 childbearing female renal recipients for presence of risk factors, the outcome of pregnancy, and maternal and fetal complications. RESULTS: Fourty-four pregnancies occurred in 41 patients (10.8%). Mean age at transplantation was 23.6 +/- 6.3 years (range, 12-38 years). Only in 5 pregnancies were there no risk factors. In 13 (29.5%) pregnancies, the previous creatinine level was >1.5 mg/dL, in 16 (36.45%), proteinuria was >500 mg/24 hours; 29 (65.9%) were hypertensive; 14 (31.8%) had a time between transplantation and pregnancy less than 2 years (mean time, 35.5 +/- 30.9 months; range, 3-120 months). The outcomes were 27 (61.4%; 11 term and 16 premature delivery) successful pregnancies, 6 (13.6%) spontaneous abortions, 10 (22.7%) therapeutic abortions, and 1 (3.2%) fetal death. Pre-eclampsia occurred in 9 (20.4%) pregnancies and eclampsia in 1 (2.2%). The mean weight of the offspring was 2195 +/- 490 g (range, 1300- 2980 g). There were 2 cases of acute fetal distress and 1 oligodramnios. Median creatinine level was 1.0 (range, 0.4-3.0) mg/dL before conception and 1.2 (range, 0.7-9.0) mg/dL 6 month after pregnancy (P <.001). The long-term patient and graft survival rates were similar for pregnant versus nonpregnant recipients in the childbearing age. CONCLUSION: Most pregnancies were successful, although the premature delivery rate was high (36.4%). Only 5 conceptions occurred in the absence of risk factors. Pregnancy did not impair the patient and graft survival during long-term follow-up.

Effectiveness of diet in hyperlipidemia in renal transplant patients.

In renal transplant patients dietary therapy alone does not always provide satisfactory results to control hyperlipidemia. To assess the effectiveness of diet, 151 renal transplant patients were selected for a prospective clinical study using pre- and posttest groups. During 8 weeks these patients received a diet with 25% energy intake from lipids, less than 10% from saturated fats, and less than 500 mg of cholesterol per day. Total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides were measured (pre- versus postdiet). The degree of compliance with the diet was measured by a 24-hour food recall record. Patients who had 90% compatibility between the questionnaire and the prescribed diet were considered compliant. The diet was considered effective in the patients who achieved a reduction of cholesterolemia to less than 200 mg/dL after 8 weeks of treatment. Ultimately 108 patients completed the study, with a significant reduction in total serum cholesterol from 262.37 mg/dL pretest to 252.85 mg/dL posttest (P =.010); LDL cholesterol from 174.29 mg/dL pretest to 166.60 mg/dL posttest (P =.036), of body weight from 68.98 kg pretest to 67.78 kg posttest (P =.01) and of body mass index from 25.86 kg/m(2) pretest to 25.41 kg/m(2) posttest (P =.01). Cholesterol variation was 3.63% as compared to prediet levels. Only 22 patients (20.4%) achieved cholesterol levels below 200 mg/dL. In conclusion, although diets decrease cholesterolemia, they alone are not effective to control hyperlipidemia in most renal transplant patients.

Immunosuppression in pancreas transplantation: mycophenolate mofetil versus sirolimus.

The use of mycophenolate mofetil (MMF) in pancreas transplantation has increased graft survival and decreased the incidence of acute rejections episodes (ARE), regardless of the choice of calcineurin inhibitor. The combination of MMF with tacrolimus (TAC) is the most common protocol, it is considered the gold standard for new protocols. In the last few years, there have been reports of a small number of patients treated with sirolimus (RAPA), usually combined with TAC. Patient and pancreas survival rates as well as the incidence of ARE were similar to protocols with TAC and MMF. Twenty simultaneous pancreas and kidney (SPK) transplantations were performed using an immunosuppressive protocol of TAC, RAPA, and steroids (STE) after 2000. The incidence of ARE was 25%; all episodes responded to STE. Only 2 patients (10%) displayed hypercholesterolemia requiring treatment with statins. The use of RAPA as an alternative to MMF is promising, although presently one with limited experience. The combination of MMF and RAPA with or without a calcineurin inhibitor is an option to be evaluated in the future.