Retroactive Application of a New Risk Index for Living Donor Kidney Transplantation to Renal Transplants in Veracruz, Mexico.

BACKGROUND: The Living Kidney Donor Profile Index (LKDPI) was recently created. This model predicts recipient risk of graft loss after living donor transplant. Herein, we applied the LDKPI to our population to analyze its performance. METHODS: A retrospective analysis of all living donor kidney transplants from 2003 to 2018 from 2 transplant centers in Veracruz, Mexico, was used. LKDPI was calculated in a webpage (www.transplantmodels.com). Donor and recipient demographics and transplant data included in the model were registered. Pearson correlation between the LKDPI percentage and death-censored graft survival was performed. Kaplan-Meier survival (log-rank) and Cox regression analysis were compared between the LKPDI quartiles. P < .05 was considered statistically significant. RESULTS: In total, 821 transplants were included (mean age 31.7 ± 10.5 years, 62.5% male, n = 513). Mean follow-up was 64.7 ± 46.2 months. Mean estimated survival (Kaplan-Meier) was 128.9 ± 3 months (95% confidence interval [CI], 123-134). Ten-year death-censored graft survival was 61.4%. Median LKPDI was -2%, and mean LKDPI was -2.6% ± 14.6% (range, -50% to 42%). Pearson coefficient correlation between the LKDPI and death-censored graft survival was 0.024 (P = .4). Area under the curve (receiver operating characteristic [ROC]) for the LKDPI and death-censored graft loss was 0.54 (95% CI, 0.505-0.591) (P = .04). Recipients with the lowest LKDPI had lower risk of death-censored graft loss than other quartiles (P = .014 log-rank). Cox regression analysis was significant for the lower LKDPI quartile (<20%) (Exp B = 0.35; 95% CI, 0.14-0.9; P = .03). CONCLUSION: The LKDPI applies with moderate discrimination predictive power in our population. The best LKDPI patient has better death-censored graft survival. Further studies might continue to validate the LKDPI in other cohorts.

Annual Analysis (2018) of the Kidney Transplant Waiting List of a Social Security Hospital in Veracruz, Mexico.

BACKGROUND: In Mexico during 2018, 15,072 patients were waiting for a deceased donor kidney transplant, and 969 deceased donor kidney transplants were performed. There is no annual data report of the waiting list activity in Mexico. Herein, we analyzed our kidney transplant waiting list activity in 2018. METHODS: We performed a waiting list analysis in our unit during 2018. Patient and status characteristics (active, deceased, inactive, or transplant) were registered. Differences between status were determined. A P < .05 was considered statistically significant. RESULTS: In total, 467 patients were waiting, and 74 patients were included on the list (57.7% male, mean age 38.5 ± 11.3 years and mean BMI 24.9 ± 4.7 kg/m2); 92.8% were state residents. The most common end-stage renal disease diagnosis was unknown (40.9%). In total, 94.9% were on dialysis (mean time 5.1 ± 3.14 years), and for 90.9%, this was the first transplant. PRA class I and class II were 19.9% ± 30.6% and 12.9% ± 27.1%, respectively. Mean EPTS was 19.8% ± 9.4%. Mean waiting time was 2.88 ± 2.3 years. In total, 21 deceased donor patients (3.9%) were transplanted; 57 (10.5%) patients had an inactive status, and 3 (0.6%) received a living donor kidney transplant with a proven mortality of 1.8% (n = 10). Patients who underwent deceased donor transplant were younger and had more time on dialysis, lower PRA class I, and more time on the waiting list (P < .05 by analysis of variance). CONCLUSION: There are more patients included on the list than patients off the list. There are significant differences between patients who received a transplant and inactive and active patients that needs to be shortened.

Effect of Panel-Reactive Antibody on Graft Survival in Living Kidney Donor Transplantation: Analysis of 10 Years in a Transplant Center in Veracruz, Mexico.

BACKGROUND: Pretransplant anti-HLA antibodies are a risk factor for graft rejection and loss, and its percentage estimate is known as panel-reactive antibody (PRA). Our objective was to evaluate the influence of PRA on the survival of renal grafts from living donors over a period of 10 years. METHODS: Retrospective analysis was completed in all living donor transplants with PRA class I and class II from October 2008 to December 2018 with follow-up until June 2019. The methods used for the PRA were flow cytometry and Luminex. Graft survival (not censored) was evaluated by Kaplan-Meier (log-rank) and Cox regression. P < .05 was considered significant. RESULTS: The study included 393 patients. PRA class I mean was 9.8 ± 20% (0%-98%) and class II mean was 8.6 ± 17.8% (0%-97.8%). Of the patients, 81.9% had a PRA <20% for any class. Uncensored graft survival at 1, 5, and 10 years was 90.3%, 76.2%, and 69.3%, respectively. Mean estimated uncensored graft survival in PRA <20% patients (103.9 ± 2.7, 95% confidence interval [CI] 96.6-11.2) was higher than that of PRA >20% patients (61.5 ± 5.7, 95% CI 50.3-72.8) (P = .005 log-rank). Cox regression (univariate) was statistically significant for PRA class I (Exp [B] 1.01, 95% CI 1.003-1.02, P = .009) and for PRA >20% any class (Exp [B] 2.074, 95% CI 1.222-3.520, P = .007). CONCLUSION: PRA class I and PRA >20% any class are associated with lower graft survival. PRA must be considered to determine immunologic risk and to choose an immunosuppressive regimen in kidney transplantation.

Conversion from calcineurin inhibitor to sirolimus for renal function deterioration in kidney allograft recipients.

BACKGROUND: Calcineurin inhibitors play an important role in chronic allograft dysfunction. Sirolimus is an interesting alternative in renal transplant patients because it is less nephrotoxic than calcineurin inhibitors. METHODS: A chart review of the clinical outcome of kidney transplant patients converted to sirolimus with progressive allograft dysfunction is reported herein. Fifteen patients (average age: 32.3 years, 44 months mean time of conversion) were included. Indication for conversion was a >20% increase in serum creatinine over the last 6 months or progression to the range of 2-4.5 mg/dL. Patients underwent abrupt cessation of cyclosporine and sirolimus addition at 2-5 mg/day. RESULTS: Concomitant immunosuppression remained unchanged during conversion. Targeted sirolimus level was 8-12 ng/mL. Serum creatinine dropped from pre-conversion level of 2.75 +/- 0.83 to 2.14 +/- 0.67 and 1.97 +/- 0.66 mg/dL at 3 and 6 months (p <0.05). There was a significant decrease in blood urea nitrogen, hemoglobin and serum calcium at 3 months post-conversion as well as serum calcium and potassium at 6 months post-conversion (p <0.05). There were no rejection episodes. Patient and graft survival was 100% with three infectious complications. CONCLUSIONS: Monitored sirolimus conversion with sharp withdrawal of calcineurin inhibitor is an alternative for patients with deteriorating renal function and chronic allograft nephropathy.

A new open anterior tension-free onlay patch technique for inguinofemoral hernia repair.

BACKGROUND: The high rate of misdiagnosed, coincident, or recurrent femoral hernias while or after mesh herniorrhaphy suggests its systematic search. We introduced a new open anterior tension-free mesh herniorrhaphy with a novel design. METHODS: A description of the operative technique and patients demographics is presented. RESULTS: Two hundred sixty-eight hernias were repaired with this technique in a 5-year period. Two hundred twelve patients had a primary inguinal hernia. An unsuspected femoral hernia was discovered in 39 patients with a preoperatively diagnosed inguinal hernia. Operative time was 45 minutes, most patients were discharged in less than 24 hours, no recurrence has been noted, and minor complications were present. Most patients had minimal pain and returned to their normal activities within 10 days after surgery. CONCLUSION: This technique has the same advantages of open tension-free repairs, allows identification of femoral hernias, and protects a herniorrhaphy for recurrence.