Semidirected Living Donors in Israel: Sociodemographic Profile, Religiosity, and Social Tolerance.

Living kidney donations in Israel come from 2 sources: family members and individuals who volunteer to donate their kidney to patients with whom they do not have personal acquaintance. We refer to the first group as directed living donors (DLDs) and the second as semidirected living donors (SDLDs). The incidence of SDLD in Israel is ∼60%, the highest in the world. We introduce results of a survey among 749 living donors (349 SDLDs and 400 DLDs). Our data illustrate the sociodemographic profile of the 2 groups and their answers to a series of questions regarding spirituality and social tolerance. We find SDLDs to be sectorial: they are mainly married middle-class religious men who reside in small communities. However, we found no significant difference between SDLDs and DLDs in their social tolerance. Both groups ranked high and expressed tolerance toward different social groups. Semidirected living donation enables donors to express general preferences as to the sociodemographic features of their respected recipients. This stirs a heated debate on the ethics of semidirected living donation. Our study discloses a comprehensive picture of the profile and attitudes of SDLDs in Israel, which adds valuable data to the ongoing debate on the legitimacy of semidirected living donation.

[ABO INCOMPATIBLE KIDNEY TRANSPLANTATION].

INTRODUCTION: With the introduction of new therapies, the ABO barrier for kidney transplantation has been breached. In the recent decade the reported results with ABO incompatible (ABOi) kidney transplantation are similar to ABO compatible transplantation. We report on our initial experience with ABOi kidney transplantation performed at the Rabin Medical Center. METHODS: During the period 3/2010 to 4/2015, 22 patients with PRA 0% underwent ABOi living-donor kidney transplantation. This group was compared to 325 non-sensitized live-donor transplant recipients of ABO-match transplants performed at the same period. The desensitization protocol included rituximab (375mg/kg/m2) and three sets of plasmapheresis every other day with IVIG (0.5g/kg) after each plasmapheresis. We compared graft and patient survivals, antibody mediated rejection (AMR) and graft function between the two groups. RESULTS: Graft survival rates at 1, 3 and 5 years in the ABOi group were 95.5% at all intervals and 99.4% for the 1st year and 97.9% at 3 and 5 years after transplant (p=ns). Patient survival rates were 100% at all intervals and 100%, 98.3% and 97.5% at 1,3, and 5 years (p=ns). Two patients (9.1%) in the ABOi group experienced antibody mediated rejection (AMR), one lost his graft. In the ABO-matched group only two patients (0.85%) experienced AMR (p<0.05). Creatinine levels at followup were not statistically different between the groups. CONCLUSIONS: ABO incompatible kidney transplantation provides an additional option for transplant with excellent results. Strict monitoring of antibody levels should be conducted after ABOi transplantation to timely intervene and prevent AMR.

Prevalence and clinical characteristics of adrenal incidentalomas in potential kidney donors.

BACKGROUND: The prevalence of adrenal incidentalomas (AIs) in asymptomatic individuals is unknown. This study evaluated the prevalence of AIs in healthy kidney donors in whom pre-operative computed tomography (CT) is performed routinely. METHODS: All potential kidney donors evaluated at the Rabin Medical Center who had routine abdominal CT were identified and their medical records were retrospectively reviewed. Subjects who had normal CT scans were compared with those with a finding of an AI, evaluating demographic (age, body mass index, systolic and diastolic blood pressure) and laboratory variables (glucose, sodium, potassium, calcium, phosphorus, albumin and creatinine). In addition, prevalence of hypertension, rate of donation and surgical mortality were compared between the two groups. RESULTS: CT was performed in 673 potential kidney donors. Of these, 645 had a normal CT and 28 (4.2%) had evidence of an AI. Those with AIs had a similar prevalence of hypertension, kidney donation and surgical mortality as those with a normal CT. Those with AIs were older (50.93 ± 11.1 versus 43.76 ± 11.1 years) but other demographic variables were similar; laboratory variables were also similar except for slightly lower albumin and creatinine in those with AIs. CONCLUSIONS: The prevalence of AIs is high even in healthy asymptomatic individuals.

Donor-specific hyporesponsiveness in ELISPOT assay is associated with early recurrence of hepatitis C in liver transplant recipients.

Recurrence of hepatitis C in liver transplant recipients is a common event that often leads to loss of the allograft. There are no means to prevent, or even predict, those patients who are more prone to early aggressive recurrence. Therefore there is an increased need for tailored immunosuppression protocols specific to this patient population. Fifteen liver transplant recipients (eight hepatitis C virus [HCV]+; 7 HCV-) were followed for 12-24 months after transplantation. The frequency of donor-specific interferon (IFN)-gamma- or interleukin-10-producing lymphocytes was monitored using ELISPOT assays. Of the eight HCV+ recipients, six experienced recurrence within the first year after transplant. All six patients had very low (negligible) frequency of donor-specific IFN-gamma precursors; in most cases not higher than the nonstimulated (spontaneous) secretion rate. The other two patients who did not recur exhibited donor-specific IFN-gamma reactivity. A significant difference in the frequency of alloantigen-specific T cells was observed between HCV+ recipients and patients with other indications for transplantation. The results of this preliminary study suggest that posttransplant monitoring of the frequency of donor-specific IFN-gamma-producing precursors may differentiate a subset of patients at risk for early recurrent hepatitis C and therefore may help to devise treatment strategies for HCV+ liver recipient after transplantation.