[Short, medium and long-term follow-up of living donors]. / Seguimiento del donante vivo a corto, medio y largo plazo.

Live-donor kidney transplants are being done since more than fifty years ago. In recent years, a marked increase in live donations is observed, as a result of the limited availability of organs from deceased donors. Also, the use of laparoscopic nephrectomy has contributed to increase live donations. A systematic review of the literature shows that short and long-term risks of morbidity and mortality of the donor are reasonably low. Even so, an increased incidence of high blood pressure and mild proteinuria has been reported. On the contrary, no detrimental effect on renal failure is observed and the incidence of long-term chronic renal failure is lower in the donor population when compared with the incidence observed in the general population. In any case, a regular follow-up of the donors is advisable in order to prevent or early detect those medical conditions that would represent a health risk, in particular those conditions that possibly will affect renal function: hypertension, diabetes, proteinuria and obesity. It would be also necessary to establish a nation-wide scientific registry, with prospective regular data collection, that will make possible a more accurate assessment of the long-term risk of uninephrectomy and early detection of new medical information that would contribute to redefine the risk of kidney donation or to establish new requisites in the donor evaluation protocols.

Seguimiento del donante vivo a corto, medio y largo plazo / Short, medium and long-term follow-up of living donors

Hace más de 50 años que se vienen practicando trasplantes renales de donante vivo, pero en años recientes el incremento de la demanda y la introducción de la nefrectomía por vía laparoscópica se han traducido en un significativo aumento de este tipo de trasplantes. Aunque la experiencia publicada demuestra que la morbilidad y mortalidad del donante, a corto y a largo plazo, es razonablemente baja, existen evidencias de que algunos donantes pueden presentar un ligero incremento de presión arterial o proteinuria, sin afectar a la función renal remanente. A largo plazo, la incidencia de insuficiencia renal en los donantes renales es inferior a la observada en la población general. Es aconsejable hacer un seguimiento clínico periódico de los donantes para prevenir o tratar los factores de riesgo y/o de complicaciones clínicas intercurrentes que pudieran comprometer su salud en general y en especial la función renal: hipertensión arterial, diabetes, proteinuria y obesidad. También es preciso disponer de un registro científico prospectivo nacional de todos los donantes, con el fin de analizar el impacto a largo plazo de la uninefrectomía y detectar, en su caso, las posibles señales de alarma que ayudarán a modificar los criterios actuales de valoración y aceptación de los candidatos a donación y/o el cuidado clínico de nuestros donantes (AU)

Live-donor kidney transplants are being done since more than fifty years ago. In recent years, a marked increase in live donations is observed, as a result of the limited availability of organs from deceased donors. Also, the use of laparoscopic nephrectomy has contributed to increase live donations. A systematic review of the literature shows that short and long-term risks of morbidity and mortality of the donor are reasonably low. Even so, an increased incidence of high blood pressure and mild proteinuria has been reported. On the contrary, no detrimental effect on renal failure is observed and the incidence of long-term chronic renal failure is lower in the donor population when compared with the incidence observed in the general population. In any case, a regular follow-up of the donors is advisable in order to prevent or early detect those medical conditions that would represent a health risk, in particular those conditions that possibly will affect renal function: hypertension, diabetes, proteinuria and obesity. It would be also necessary to establish a nation-wide scientific registry, with prospective regular data collection, that will make possible a more accurate assessment of the long-term risk of uninephrectomy and early detection of new medical information that would contribute to redefine the risk of kidney donation or to establish new requisites in the donor evaluation protocols (AU)

Quality of life in simultaneous pancreas-kidney transplant recipients.

BACKGROUND: Simultaneous pancreas-kidney transplantation (SPK Tx) allows dialysis and insulin therapy to be discontinued and improves the complications of diabetes mellitus type 1 (DM1). This study measure quality of life (QoL) in SPK transplant recipients and determine if there are differences in QoL between these patients and those with DM1 in renal replacement therapy (RRT). METHODS: Short Form Health Survey 36-Item (SF-36) was administered to 69 SPK transplant recipients and 34 patients with DM1 under RRT. A descriptive analysis, multiple linear regression, ANOVA, and ordinal regression (PLUM) models were constructed. RESULTS: QoL was higher in SPK transplant recipients than in patients receiving RRT. The best results were in the recently transplanted patients. Respect to Spanish population the men with SPK transplants scored higher on vitality and lower on general health, role limitations-physical and role limitations-emotional. Women with SPK transplants scored lower on general health. Among patients under RRT, men scored lower on the general health, physical functioning, vitality, and bodily pain while women scored lower on all dimensions. In both groups, greater age was associated with better mental health. CONCLUSION: Positive predictive factors of QoL are SPK Tx and age while negative predictive factors are female sex and RRT.

[Long term results of living donor kidney transplantation: graft and patient survival]. / Resultados a largo plazo del trasplante renal de donante vivo: supervivencia de injerto y receptor.

Donor kidney transplantation's graft and patient survivals are better than cadaver donor's. In Spain, living donor kidney transplantation hardly accounts for 1% of transplant activity in comparison to 60% in United States. Accordingly to bibliography, the experience of the Renal Transplant Unit of the Hospital Clinic de Barcelona has demonstrated better graft and receptor survival for living donor recipients. The analysis of 184 living donor kidney transplants and 1678 cadaver donor transplants performed between 1978 and 2002 showed that graft survival was higher in the group of living donors (p < 0.01). At the same time, graft survival was clearly better in receptors of HLA haploidentical grafts (n=142) (p < 0.05). The introduction of new and better immunosuppressive drugs, as well as better diagnostic and therapeutic management of acute rejection, prophylaxis for infections, and control of complications have contributed to better results. The absence of acute rejection between 1978 and 1983 was 45.1%, between 1984 and 1998 was 57.3% and 84.7% between 1999 and 2003. In conclusion, these results demonstrate better graft and patient survival for living donor kidney transplants in comparison with cadaver donor receptors. Altogether with the low risk involved for donors should incentivate authorities, professionals, and patients to promote these therapeutic option by means of adequate information and wider diffusion. Living donor kidney transplantation should contribute together with cadaver kidney transplantation to lessen our long waiting lists, because they are not excluding options.

Resultados a largo plazo del trasplante renal de donante vivo: supervivencia de injerto y receptor / Long term results of living donor kidney transplantation: graft and patient survival

Los resultados en la supervivencia delinjerto y del paciente en el trasplante renal de donantevivo son superiores a los obtenidos en el trasplanterenal de donante cadáver. En España, el trasplanterenal de vivo apenas supone el 1% de la actividad totalfrente al 60% en Estados Unidos. De acuerdo con laliteratura, la experiencia de la Unidad de TrasplanteRenal del Hospital Clinic de Barcelona ha demostradouna mejor supervivencia de injerto y receptor en elgrupo de receptores de injertos de donante vivo. Elanálisis de 184 trasplantes renales de donante vivo y1678 trasplantes renales de donante cadáver realizadosentre los años 1978 y 2002 mostró que la supervivenciadel injerto fue superior en el grupo de donante vivo (p<0.01). A su vez, la supervivencia del injertoresultó claramente mejor en los receptores de un injertode donante vivo HLA idéntico (n=38) en comparacióncon los receptores de un injerto HLA haploidéntico(n=142) (p<0.05). La introducción de más y mejoresfármacos inmunosupresores, así como un mejor manejodiagnóstico y terapéutico del rechazo agudo, la profilaxisinfecciosa y el control de las complicaciones hancontribuido a una mejoría en los resultados del trasplante.Asimismo, con el paso de los años se ha idoreduciendo de forma considerable la incidencia derechazo agudo. Entre los años 1978 y 1983 la ausenciade rechazo agudo fue del 45,1%, entre los años1984 y 1998 del 57,3%, y del 84,7% entre los años1999 y 2003.En conclusión, estos resultados demuestran una mejorsupervivencia de los injertos y receptores de trasplanterenal de donante vivo en comparación con los receptoresde donante cadáver, así como el bajo riesgo quesupone para el donante, deben incentivar a las autoridades,a los profesionales y a los pacientes a promocionaresta alternativa terapéutica mediante una informaciónadecuada con mayor difusión. El trasplanterenal de donante vivo debe contribuir junto con el trasplantede cadáver, puesto que no son opciones excluyentes,a paliar nuestras largas listas de espera

Donor kidney transplantation’s graft and patient survivals are better than cadaver donor’s. In Spain, living donor kidney transplantation hardly accounts for 1% of transplant activity in comparison to 60% in United States. Accordingly to bibliography, the experience of the Renal Transplant Unit of the Hospital Clinic de Barcelona has demonstrated better graft and receptor survival for living donor recipients. The analysis of 184 living donor kidney transplants and 1678 cadaver donor transplants performed between 1978 and 2002 showed that graft survival was higher in the group of living donors (p < 0.01). At the same time, graft survival was clearly better in receptors of HLA haploidentical grafts (n =142) (p < 0.05). The introduction of new and better immunosuppressive drugs, as well as better diagnostic and therapeutic management of acute rejection, prophylaxis for infections, and control of complications have contributed to better results. The absence of acute rejection between 1978 and 1983 was 45.1%, between 1984 and 1998 was 57.3% and 84.7% between 1999 and 2003. In conclusion, these results demonstrate better graft and patient survival for living donor kidney transplants in comparison with cadaver donor receptors. Altogether with the low risk involved for donors should incentivate authorities, professionals, and patients to promote these therapeutic option by means of adequate information and wider diffusion. Living donor kidney transplantation should contribute together with cadaver kidney transplantation to lessen our long waiting lists, because they are not excluding options