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outcomes of renal transplantation

Vina P Nguyen, Heather Landau, Karen Quillen, Dina Brauneis, Anthony C Shelton, Lisa Mendelson, Hafsa Rahman, J Mark Sloan, Shayna Sarosiek, Vaishali Sanchorawala
High dose melphalan and autologous stem cell transplantation (HDM/SCT) has been used in patients with light chain (AL) amyloidosis for over two decades now with durable responses, prolonged survival, and decreasing treatment related mortality. Historically patients with poorer baseline functional status, advanced age, renal compromise and cardiac involvement have been treated with a risk-adapted modified conditioning dose of melphalan (mHDM) of 100-140 mg/m2 prior to SCT. Due in part to these baseline characteristics, patients receiving mHDM/SCT have had poorer outcomes compared to patients receiving full dose of melphalan at 200 mg/m2 ...
June 19, 2018: Biology of Blood and Marrow Transplantation
Victoria Gómez-Dos Santos, Mercedes Ruiz Hernández, Francisco Javier Burgos-Revilla
BACKGROUND: Hypothermic machine perfusion (HMP) of deceased donor kidneys is associated with a better outcome than static cold storage, predominantly in marginal donors. Nevertheless, there is little evidence supporting whether graft centre of origin and donor category impact HMP results. OBJECTIVE: To identify factors impacting HMP in transplantation from marginal donors. DESIGN, SETTING, AND PARTICIPANTS: Analysis of prospectively collected cohort data of expanded criteria donor (ECD) and donor after circulatory death (DCD) categories II and III was performed...
June 18, 2018: European Urology Focus
Alan S Go, Jingrong Yang, Thida C Tan, Claudia S Cabrera, Bergur V Stefansson, Peter J Greasley, Juan D Ordonez
BACKGROUND: Chronic kidney disease (CKD) is highly prevalent but identification of patients at high risk for fast CKD progression before reaching end-stage renal disease in the short-term has been challenging. Whether factors associated with fast progression vary by diabetes status is also not well understood. We examined a large community-based cohort of adults with CKD to identify predictors of fast progression during the first 2 years of follow-up in the presence or absence of diabetes mellitus...
June 22, 2018: BMC Nephrology
Vital Hevia, Romain Boissier, Óscar Rodríguez-Faba, Claire Fraser-Taylor, Rhana Hassan-Zakri, Enrique Lledo, Heinz Regele, Klemens Buddde, Arnaldo Figueiredo, Jonathon Olsburgh, Alberto Breda
CONTEXT: Cancer development after kidney transplant (KT) has become a major problem, and currently, it is one of the primary causes of death in this population. Urological cancers after KT such as prostate cancer (PCa) have also increased, partly due to the increasing age of recipients and prolonged survival. PCa is the second most commonly diagnosed cancer in men, accounting for 15% of all cancers. Managing localised PCa after KT remains challenging because of treating an immunosuppressed patient with a kidney graft in the pelvic cavity...
June 16, 2018: European Urology Focus
Mari Ohtaka, Takashi Kawahara, Daiji Takamoto, Taku Mochizuki, Hiroaki Ishida, Yusuke Hattori, Kazuhide Makiyama, Masahiro Yao, Jun-Ichi Teranishi, Hiroji Uemura
OBJECTIVES: Because of recent developments in immunosuppressive therapy, renal transplant outcomes have improved. Although reports on the association between immunosuppressive therapy and malignant disease are available, the results are controversial. The neutrophil-to-lymphocyte ratio has been reported as an easy tumor marker for predicting the prognoses of some solid tumors. In the present study, we examined changes in neutrophil-to-lymphocyte ratio after renal transplant and discussed cases in which malignant disease developed after renal transplant...
June 18, 2018: Experimental and Clinical Transplantation
Koji Nanmoku, Akira Kurosawa, Taro Kubo, Takahiro Shinzato, Toshihiro Shimizu, Takaaki Kimura, Takashi Yagisawa
OBJECTIVES: Although steroid withdrawal has been attempted to ameliorate various complications in kidney transplant recipients, a steroid-sparing strategy has more frequently led to acute rejection. We investigated the use of everolimus to safely overcome steroid withdrawal in kidney transplant recipients with posttransplant diabetes mellitus under maintenance immunosuppressive therapy. MATERIALS AND METHODS: A total of 75 de novo consecutive kidney transplant recipients received conventional immunosuppressive therapy comprising tacrolimus (trough level of 5 ng/mL), mycophenolate mofetil (1000 mg), and methylprednisolone (4 mg)...
June 18, 2018: Experimental and Clinical Transplantation
David Ouyang, Gunsagar Gulati, Richard Ha, Dipanjan Banerjee
BACKGROUND: Proposed changes to the United Network for Organ Sharing heart transplant allocation protocol will prioritize patients receiving temporary mechanical circulatory support (tMCS), including extracorporeal membrane oxygenation (ECMO), percutaneous ventricular assist devices (PVADs), and intra-aortic balloon pumps (IABPs). We sought to evaluate contemporary trends in the incidence and outcomes of patients who required tMCS during the hospitalization before heart transplantation...
April 26, 2018: Journal of Heart and Lung Transplantation
Michael Eder, Christoph Schwarz, Michael Kammer, Niels Jacobsen, Stavroula Masouridi Levrat, Morton J Cowan, Tepsiri Chongkrairatanakul, Robert Gaston, Rommel Ravanan, Hideki Ishida, Anette Bachmann, Sergio Alvarez, Martina Koch, Cyril Garrouste, Ulrich A Duffner, Brett Cullis, Nicolaas Schaap, Michael Medinger, Søren Schwartz Sørensen, Eva-Maria Dauber, Georg Böhmig, Heinz Regele, Gabriela A Berlakovich, Thomas Wekerle, Rainer Oberbauer
Tolerance induction through simultaneous hematopoietic stem cell- and renal transplantation has shown promising results, but it is hampered by the toxicity of preconditioning therapies and graft-versus-host disease. Moreover, renal function has never been compared to conventionally transplanted patients, thus, whether donor-specific tolerance results in improved outcomes remains unanswered. We collected follow-up data of published cases of renal transplantations after hematopoietic stem cell transplantation from the same donor and compared patient- and transplant kidney survival- as well as function with caliper-matched living-donor renal transplantations from the Austrian dialysis and transplant registry...
June 13, 2018: American Journal of Transplantation
Maria C Haller, Michael Kammer, Rainer Oberbauer
Pre-emptive kidney transplantation is the recommended strategy for patients with end-stage renal failure in all guidelines [Kidney Disease: Improving Global Outcomes (KDIGO), The Australian and New Zealand Dialysis and Transplantation Registry (ANZDATA), European Renal Best Practice Guideline (ERBP), British Transplant Society (BTS)]. This recommendation is intuitive and based on few older studies with considerable limitations. In addition, there is conflicting evidence as to whether the duration of dialysis vintage impacts on graft and patient survival after transplantation...
April 20, 2018: Nephrology, Dialysis, Transplantation
Eva Tschiedel, Roland Assert, Ursula Felderhoff-Müser, Simone Kathemann, Oliver Witzke, Peter Hoyer, Christian Dohna-Schwake
INTRODUCTION AND AIM: Procalcitonin is widely used as a biomarker to distinguish bacterial infections from other etiologies of systemic inflammation. Little is known about its value in acute liver injury resulting from intoxication with paracetamol. MATERIAL AND METHODS: We performed a single-center retrospective analysis of the procalcitonin level, liver synthesis, liver cell damage and renal function of patients admitted with paracetamol-induced liver injury to a tertiary care children's hospital...
July 2018: Annals of Hepatology
Sujay Kulkarni, Mithun Sharma, Padaki N Rao, Rajesh Gupta, Duvvuru N Reddy
Aims: We studied in-hospital predictors of mortality of acute on chronic liver failure (ACLF) in Indian patients. Methods: Patients admitted to the intensive care unit of our institute fulfilling the definition of ACLF based on the Asia-Pacific Association for Study of Liver Disease (APASL) consensus were included. Complete history and medical evaluation to assess the etiology of underlying liver cirrhosis and to identify the acute precipitating insult of worsening liver function was done...
June 2018: Journal of Clinical and Experimental Hepatology
Charles D Fraser, Joshua C Grimm, Rui Han Liu, Russell N Wesson, Faris Azar, Robert J Beaulieu, Thomas Reifsnyder
INTRODUCTION: Renal transplant recipients often maintain their hemodialysis access in the event of future allograft failure. Patients may develop complications related to the unused dialysis access and it also limits vein availability for phlebotomy. Accordingly, a change in the current paradigm may be warranted. This study evaluates the indications for, and safety of, arteriovenous fistula (AVF) removal in patients following successful renal transplantation. METHODS: All patients that underwent AVF excision at a single institution from 2006-2016 were retrospectively reviewed...
June 7, 2018: Annals of Vascular Surgery
Pratik B Shah, Manpreet Samra, Michelle A Josephson
PURPOSE OF REVIEW: To review the studies and practice guidelines on the preeclampsia risks in kidney donors and recipients. RECENT FINDINGS: There is a small increased risk of gestational hypertension and preeclampsia in pregnancies that follow kidney donation. Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guideline (2017) and the 2015 American Society of Transplantation (AST) consensus conference statement recommends counseling kidney donors about this increased risk...
June 8, 2018: Current Hypertension Reports
Birgith Engelst Grove, Liv Marit Schougaard, Niels Henrik Hjollund, Per Ivarsen
OBJECTIVE: Patient-reported health status, including symptom burden, functional status and quality of life, are important measures of health in patients with chronic kidney disease. We aimed to investigate patient-reported outcomes (PRO) on self-rated health, appetite, quality of life and their associations with clinical outcomes. We conducted a prospective observational cohort study. Data was collected at baseline using a PRO questionnaire. The primary outcomes were initiation of dialysis, transplantation and mortality...
June 8, 2018: BMC Research Notes
Christopher W Ives, Wael A AlJaroudi, Vineeta Kumar, Ayman Farag, Dana V Rizk, Suzanne Oparil, Ami E Iskandrian, Fadi G Hage
PURPOSE: Noninvasive stress testing is commonly performed as part of pre-renal transplantation (RT) evaluation. We evaluated the prognostic value of myocardial perfusion imaging (MPI)-myocardial perfusion, left ventricular ejection fraction (LVEF) and heart rate response (HRR)-post-RT. METHODS: Consecutive RT recipients were identified at our institution. MPI was considered abnormal when there was a perfusion defect or reduced ejection fraction. HRR to vasodilator stress was calculated as percentage change from baseline...
June 7, 2018: European Journal of Nuclear Medicine and Molecular Imaging
F J Romeo, C F Varela, N Vulcano, R Pizarro, G Greloni, R Posatini, R Marenchino, G J Rosa-Diez, C A Belziti
BACKGROUND: Heart transplantation (HT) is regarded as the treatment of choice for end-stage heart failure (ESHF) patients. Severe acute kidney injury (AKI) after HT is a frequent clinical problem with devastating consequences for HT recipients. METHODS: Data from 112 ESHF patients undergoing HT in 2010-2015 were retrospectively reviewed. The primary end point was the development of AKI stage III, and secondary outcomes were in-hospital and 1-year mortality according to Kidney Disease Improving Global Outcomes criteria...
June 2018: Transplantation Proceedings
G E Gondolesi, N F Aguirre, D A Ramisch, F A Mos, N F Pedraza, M R Fortunato, L M Gutiérrez, H Fraguas, R Marrugat, G E Rabin, C Musso, P A Farinelli, P H L Barros Schelotto, P M Raffaele
BACKGROUND: Simultaneous pancreas-kidney transplantation (SPK) has become the treatment of choice for type 1 diabetes mellitus (T1DM) patients with chronic renal failure. Type 2 diabetes mellitus (T2DM), was once considered to be a contraindication for pancreas transplantation; however, it has been accepted as a new indication, under strict criteria. Although favorable results have increase the indication for T2DM in developed countries, there have been no reports of long-term results for this indication from Latin American centers...
June 2018: Transplantation Proceedings
R S Mangus, S B Kinsella, D T Farar, J A Fridell, L T Woolf, C A Kubal
BACKGROUND: Few studies have assessed the ability of inhaled anesthetic agents to ameliorate ischemia-reperfusion injury (IRI) in liver transplantation (LT). This study compares inhaled anesthetics in early liver allograft IRI. LT recipient and organ donor data were extracted retrospectively for all LTs at a single center between 2001 and 2015. METHODS: LT recipient and organ donor data were extracted retrospectively for all LTs at a single center between 2001 and 2015...
June 2018: Transplantation Proceedings
H Antunes, B Parada, E Tavares-da-Silva, J Carvalho, C Bastos, A Roseiro, P Nunes, A Figueiredo
BACKGROUND: In Europe, pediatric transplantation accounts for only about 4% of all kidney transplantations performed. The aim of our work is to evaluate the evolution of pediatric renal transplantation in our department over time, but also to compare this special population with the adult one. METHODS: We evaluated all pediatric renal transplantations performed in our department between January 1981 and December 2016. We performed the analysis of clinical, analytical, and surgical factors to look for predictive factors of graft loss or decrease of survival...
June 2018: Transplantation Proceedings
D Zhu, K McCague, W Lin, R Rong, M Xu, L Chan, T Zhu
BACKGROUND: Kidney transplantation is limited by the shortage of donor kidneys. Donation after cardiac death (DCD) has been explored to alleviate this problem. To better understand the outcome of DCD kidney transplantation, we reanalyzed the Mycophenolic Renal Transplant (MORE) Registry. METHODS: We compared delayed graft function (DGF), biopsy-proved acute rejection (BPAR), graft loss, and patient death between DCD and donation after brain death (DBD) kidney transplantations...
June 2018: Transplantation Proceedings
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