Increased urine transforming growth factor ß1 (TGF-ß1) and serum uric acid are associated with an early decline of glomerular filtration rate in kidney transplant recipients.

BACKGROUND: The renin-angiotensin system (RAS) and transforming growth factor ß1 (TGF-ß1) may play a role in the pathogenesis of fibrosis in kidney allografts. Experimental hyperuricemia shows activation of intrarenal RAS. However, the association between uric acid (UA), RAS, and TGF-ß1 in allograft recipients has not been demonstrated. Therefore we investigated the association between serum UA levels, RAS, and TGF-ß1 in kidney transplant recipients during the 1st year after transplantation. METHODS: Sixty-two transplant recipients were included in the study. Serum UA level, plasma renin activity (PRA), and urine TGF-ß1 concentration were studied at 3, 6, and 12 months after transplantation. Statistical correlation was demonstrated with the use of Spearman rank correlation coefficient. Receiver operating characteristic curve analysis and area under the curve were performed to assess the diagnostic performance to discriminate between estimated glomerular filtration rate (eGFR) <60 and ≥ 60 mL/min/1.73 m(2). RESULTS: For all 62 patients, urine TGF-ß1 and serum UA had a tendency to increase during the 1-year follow-up period, despite no statistically significant change in eGFR. We found that increased urine TGF-ß1 was correlated with rising serum UA levels and a decrease of the eGFR (r = 0.27 [P = .01]; r = -0.38 [P = .0003]). In contrast, there was no significant change in PRA and it was not correlated with eGFR or TGF-ß1 (r = -0.01; P = .93). CONCLUSIONS: Increased urine TGF-ß1 and serum UA level during the 1st year after transplantation correlated with a decline in eGFR. The evaluation of these parameters in the early post-transplantation period may identify patients at risk of allograft dysfunction.

Comparative outcomes of open nephrectomy, hand-assisted laparoscopic nephrectomy, and full laparoscopic nephrectomy for living donors.

OBJECTIVE: Kidney transplantation is a standard treatment for end-stage renal disease. There are many methods of harvesting kidneys from living donors. At present, the role of minimally invasive surgery, including hand-assisted and full laparoscopic nephrectomy, is well established and tends to replace open surgery at many institutions. We conducted a retrospective study to compare the outcomes of these operative procedures at Ramathibodi Hospital in Bangkok. MATERIALS AND METHODS: We retrospectively reviewed 200 patients who underwent open nephrectomy (ON), hand-assisted laparoscopic nephrectomy (HALN), and full laparoscopic nephrectomy (FLN) between January 2006 and November 2010. Demographic data, type of surgical procedure, operative time, warm ischemic time (WIT), length of hospital stay (LOH), estimated blood loss (EBL), analgesic use, and complications from surgery were recorded. Results were compared using a one-way analysis of variance in order to determine differences. RESULTS: During the study period, 200 living kidney donors underwent nephrectomy. Of these, 95 (47.5%) received ON, 23 (11.5%) received HALN, and 82 (41%) received FLN. The operative time for the patients who underwent HALN and FLN was statistically significantly longer than that of the patients who underwent ON. On the other hand, the EBL for the ON group was significantly greater than for the HALN and FLN groups. The WIT was shortest for the ON group, followed by the HALN and FLN groups. The LOH did not differ among the three groups. Analgesic use was significantly higher in the ON group. Surgical complications were identified in 24 patients (12%). CONCLUSION: Our results show that laparoscopic living donor nephrectomy is a relatively safe procedure when performed by experienced surgeons at appropriate institutions. Though the operative times and WITs were slightly longer and the cost was higher for the laparoscopic groups, the EBL was lower and the pain score was lower. Indeed, laparoscopic living donor nephrectomy is an attractive alternative surgical procedure. However, there is a long learning curve and experienced surgeons are required.