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Living donor kidney transplant

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https://www.readbyqxmd.com/read/29457269/ambulatory-blood-pressure-monitoring-in-living-kidney-donors-what-changes-in-ten-years
#1
Serkan Feyyaz Yalin, Sinan Trabulus, Nurhan Seyahi, Mahir Cengiz, Mustafa Erdogan Cicik, Mehmet Riza Altiparmak
In renal transplantation, living donations have more significant benefits compared to cadaveric donations. However, a probable increase in blood pressure following donation should also be kept in mind. In this study, we investigated the long-term changes in blood pressure in living kidney donors using ambulatory blood pressure monitoring and we explored the e-GFR and albuminuria/proteinuria measurements at three time points. Twenty-eight living kidney donors and 39 healthy individuals were evaluated and compared at the baseline and later at the 10th year...
February 19, 2018: Clinical Transplantation
https://www.readbyqxmd.com/read/29451350/an-economic-assessment-of-contemporary-kidney-transplant-practice
#2
David Axelrod, Mark A Schnitzler, Huiling Xiao, William Irish, Elizabeth Tuttle-Newhall, Su-Hsin Chang, Bertram L Kasiske, Tarek Alhamad, Krista L Lentine
Kidney transplant is the optimal therapy for end stage renal disease, prolonging survival and reducing healthcare spending. Prior economic analyses of kidney transplant using Markov models, have generally assumed compatible, low risk, donors. The economic implications of using deceased donor kidneys with high kidney donor profile index (KPDI) scores, ABO incompatible or HLA incompatible living donors has not been assessed. The costs of transplant and dialysis were compared using discrete event simulation over a 10-year period, using data from the United States Renal Data System, Vizient ™ (Irving, Texas), and literature review...
February 16, 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/29449524/transplant-center-variability-in-disparities-for-african-american-kidney-transplant-recipients
#3
David J Taber, Mulugeta Gebregziabher, Titte Srinivas, Leonard E Egede, Prabhakar K Baliga
BACKGROUND Disparities research has traditionally focused on patient-level variables to ascertain predominant risk factors driving differences in outcomes for African-American (AA) kidney transplant recipients. Our objectives were to determine the magnitude and impact of transplant center variability for graft outcome disparities. MATERIAL AND METHODS This was a retrospective cohort study analyzing 25 years of U.S. national transplant registry data at both the patient and center levels using univariate descriptive statistics and multivariable modeling...
February 16, 2018: Annals of Transplantation: Quarterly of the Polish Transplantation Society
https://www.readbyqxmd.com/read/29446209/effect-of-the-ichoose-kidney-decision-aid-in-improving-knowledge-about-treatment-options-among-transplant-candidates-a-randomized-controlled-trial
#4
Rachel E Patzer, Laura McPherson, Mohua Basu, Sumit Mohan, Michael Wolf, Mariana Chiles, Allison Russell, Jennifer C Gander, John J Friedewald, Daniela Ladner, Christian P Larsen, Thomas Pearson, Stephen Pastan
We previously developed a mobile- and web-based decision aid (iChoose Kidney) that displays individualized risk estimates of survival and mortality, for the treatment modalities of dialysis versus kidney transplantation. We examined the effect of iChoose Kidney on change in transplant knowledge and access to transplant in a randomized controlled trial among patients presenting for evaluation in three transplant centers. A total of 470 patients were randomized to standard transplantation education (control) or standard education plus iChoose Kidney (intervention)...
February 15, 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/29442469/brain-death-associated-pathological-events-and-therapeutic-options
#5
REVIEW
Paweł Chudoba, Wojciech Krajewski, Joanna Wojciechowska, Dorota Kamińska
BACKGROUND: At present, organ transplantation is the most efficient treatment of end-stage failure of various organs, including the heart, lungs, pancreas, intestines, kidney, and liver. Despite the efforts to use organs from living donors or from donors after circulatory death, most of the organs are recovered from brain dead (BD) donors. METHODS: The Medline and Web of Science databases were searched without time limit on November 2015 using the terms "brain dead donor" and "deceased donor" in conjunction with "transplantation", "graft", "organ", "hemodynamic", "hormonal", or "management"...
December 2017: Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University
https://www.readbyqxmd.com/read/29442420/a-liver-for-a-kidney-ethics-of-trans-organ-paired-exchange
#6
Benjamin Samstein, Inmaculada de Melo-Martin, Sandip Kapur, Lloyd Ratner, Jean Emond
Living donation provides important access to organ transplantation, which is the optimal therapy for patients with end-stage liver or kidney failure. Paired exchanges have facilitated thousands of kidney transplants and enable transplantation when the donor and recipient are incompatible. However, frequently willing and otherwise healthy donors have contraindications to donation of the organ that their recipient needs. Trans-organ paired exchanges would enable a donor associated with a kidney recipient to donate a lobe of liver and a donor associated with a liver recipient to donate a kidney...
February 14, 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/29437286/kidney-exchange-match-rates-in-a-large-multicenter-clearinghouse
#7
Courtenay M Holscher, Kyle Jackson, Eric Kh Chow, Alvin G Thomas, Christine E Haugen, Sandra R DiBrito, Carlin Purcell, Matthew Ronin, Amy D Waterman, Jacqueline Garonzik Wang, Allan B Massie, Sommer E Gentry, Dorry L Segev
Kidney paired donation (KPD) can facilitate living donor transplantation for candidates with an incompatible donor, but requires waiting for a match while suffering the morbidity of dialysis. The balance between waiting for KPD versus desensitization or deceased donor transplantation relies on the ability to estimate KPD wait times. We studied donor/candidate pairs in the National Kidney Registry (NKR), a large multi-center KPD clearinghouse, between 10/2011-9/2015 using a competing risk framework. Among 1894 candidates, 52% were male, median age was 50 years, 66% were white, 59% had blood type O, 42% had PRA>80, and 50% obtained KPD through NKR...
February 13, 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/29437270/clinicians-attitudes-and-approaches-to-evaluating-the-potential-living-kidney-donor-recipient-relationship-an-interview-study
#8
Angelique F Ralph, Phyllis Butow, Jonathan C Craig, Jeremy R Chapman, John S Gill, John Kanellis, Allison Tong
AIM: Careful assessment of the potential donor-recipient relationship is recommended by guidelines to prevent undue coercion, and ensure realistic expectations and genuine motivations. However, relationships are complex, nuanced and value-laden, and can be challenging to evaluate in living kidney donation. We aimed to describe the attitudes and approaches of transplant clinicians towards assessing the relationship between potential living kidney donors and their recipients. METHODS: Semi-structured interviews were conducted with 54 transplant clinicians (nephrologists, surgeons, coordinators, social workers, psychiatrists and psychologists) from 32 transplant centres across nine countries including Australia, United States, Canada and New Zealand...
February 13, 2018: Nephrology
https://www.readbyqxmd.com/read/29433988/effectiveness-and-harms-of-using-kidneys-with-small-renal-tumors-from-deceased-or-living-donors-as-a-source-of-renal-transplantation-a-systematic-review
#9
REVIEW
Vital Hevia, Rhana Hassan Zakri, Claire Fraser Taylor, Harman Maxim Bruins, Romain Boissier, Enrique Lledo, Heinz Regele, Klemens Budde, Arnaldo Figueiredo, Alberto Breda, Cathy Yuhong Yuan, Jonathon Olsburgh
CONTEXT: Kidney transplantation is the best treatment for patients with end-stage renal disease. Incidence of small renal masses (SRMs), which most frequently are renal cell carcinomas (RCCs), is highest in patients aged >60 yr. The increasing age of donors can lead to the diagnosis of a higher number of SRMs when assessing the patient for transplantation, and so can theoretically decrease the number of kidneys suitable for transplantation. Aiming to increase the pool of kidneys suitable for transplantation, a number of studies have reported their experience using kidneys with SRMs for transplantation...
February 9, 2018: European Urology Focus
https://www.readbyqxmd.com/read/29430739/racial-disparities-in-kidney-transplant-waitlist-appearance-in-chicago-is-it-race-or-place
#10
Robert B Peng, Haena Lee, Zheng T Ke, Milda R Saunders
BACKGROUND: Prior work has demonstrated how neighborhood poverty and racial composition impact racial disparities in access to the deceased donor kidney transplant waitlist, both nationally and regionally. We examined the association between neighborhood characteristics and racial disparities in time to transplant waitlist in Chicago, a diverse city with continued neighborhood segregation. METHODS: Using data from the United States Renal Data System (USRDS) and the US Census, we investigated time from dialysis initiation to kidney transplant waitlisting for African American and white patients in Chicago using cause-specific proportional hazards analyses, adjusting for individual sociodemographic and clinical characteristics, as well as neighborhood poverty and racial composition...
February 11, 2018: Clinical Transplantation
https://www.readbyqxmd.com/read/29427562/liver-paired-exchange-can-the-liver-emulate-the-kidney
#11
Ashish Mishra, Alexis Lo, Grace S Lee, Benjamin Samstein, Peter S Yoo, Matthew H Levine, David S Goldberg, Abraham Shaked, Kim M Olthoff, Peter L Abt
Kidney paired exchange (KPE) constitutes 12 percent of all living donor kidney transplants in the United States. 1 The success of KPE programs has prompted many in the liver transplant community to consider the possibility of liver paired exchange (LPE). Though the idea seems promising, the application has been limited to a handful of centers in Asia. 2,3 In this manuscript we consider the indications, logistical issues, and ethics for establishing a LPE program in the United States with reference to the principles and advances developed from experience with KPE...
February 10, 2018: Liver Transplantation
https://www.readbyqxmd.com/read/29412699/identification-of-differential-gene-expression-patterns-in-human-arteries-from-patients-with-chronic-kidney-disease
#12
Jane Stubbe, Vibe Skov, Helle Charlotte Thiesson, Karl Egon Larsen, Maria Lyck Hansen, Boye L Jensen, Bente Jespersen, Lars M Rasmussen
BACKGROUND: Uremia accelerates atherosclerosis but little is known about affected pathways in human vasculature. This study aimed to identify differentially expressed arterial transcripts in patients with chronic kidney disease (CKD) Methods: Global mRNA expression was estimated by microarray hybridization in iliac arteries (n=14) from renal transplant recipients and compared with renal arteries from healthy living kidney donors (n=19) in study 1. Study 2 compared non-atherosclerotic internal mammary arteries (IMA) from five patients with elevated plasma creatinine levels and age and gender matched controls with normal levels...
February 7, 2018: American Journal of Physiology. Renal Physiology
https://www.readbyqxmd.com/read/29409743/tolerance-induction-in-hla-disparate-living-donor-kidney-transplantation-by-facilitating-cell-enriched-donor-stem-cell-infusion-the-importance-of-durable-chimerism
#13
REVIEW
Joseph R Leventhal, Suzanne T Ildstad
Successful solid organ transplantation currently requires the life-long use of medications to suppress the immune system in order to prevent transplant rejection. Drug-based immunosuppression significantly increases the risk of infection and cancer, as well as being very costly. Development of new therapies to minimize or eliminate entirely the need for anti-rejection drugs is of great interest to the transplant community. Therapeutic cell transfer for the control of the human immune system represents a compelling approach to reduce or eliminate the need for anti-rejection drugs...
February 2, 2018: Human Immunology
https://www.readbyqxmd.com/read/29408689/updated-follow-up-of-a-tolerance-protocol-in-hla-identical-renal-transplant-pairs-given-donor-hematopoietic-stem-cells
#14
REVIEW
Joseph R Leventhal, Joshua Miller, James M Mathew, Sunil Kurian, Anat R Tambur, John Friedewald, Jane Charrette, Michael M Abecassis
Kidney transplant recipients given donor hematopoietic stem cells from their HLA-identical living related donors have now been followed between 5 and 9 ½ years post-operatively. Recipients who were designated as tolerant (Tol) have remained so since the last report when the 5 year (biopsy associated) milestone was reached. There has been 1 mortality of a Tol patient, unrelated to the study protocol, while 5 (of 15) have remained Tol between 7 & 8 ½ years post-operatively. There has been continuing elevated T-regulatory (CD4+CD25HighCD127-FOXP3+) cells in PBMC previously reported on...
January 30, 2018: Human Immunology
https://www.readbyqxmd.com/read/29407333/eculizumab-for-prevention-of-antibody-mediated-rejection-in-blood-group-incompatible-renal-transplantation
#15
P West-Thielke, K Progar, M Campara, N Jasiak, L Gallon, I Tang, M Spaggiari, I Tzvetanov, E Benedetti
Antibody-mediated rejection (AMR) is one of the leading causes of allograft failure especially in patients undergoing ABO-incompatible (ABOi) renal transplantation. We hypothesized that complement inhibition with eculizumab, a C5 inhibitor, would protect against AMR and maintain graft function in ABOi renal transplant recipients. Four patients undergoing living donor kidney transplant from ABOi donors were treated with a 9-week eculizumab course without therapeutic plasma exchange, intravenous immunoglobulin, or splenectomy...
January 2018: Transplantation Proceedings
https://www.readbyqxmd.com/read/29407330/kidneys-with-small-renal-cell-carcinoma-used-in-transplantation-after-ex%C3%A2-vivo-partial-nephrectomy
#16
X Wang, X Zhang, T Men, Y Wang, H Gao, Y Meng, J Wang
BACKGROUND: The increase in the prevalence of end-stage renal disease in developed countries and the shortage of deceased donors have made it necessary to increase the graft pool by means of several strategies, such as living donation, non-heart-beating organ donors, and expanded-criteria donors. This study aimed to assess the short-term outcomes of donor kidneys with small (≤3.5 cm) renal cell carcinoma (sRCC) and to evaluate the possibility of using marginal kidneys in renal transplantation...
January 2018: Transplantation Proceedings
https://www.readbyqxmd.com/read/29399926/the-choice-between-deceased-vs-living-donor-renal-transplantation-in-children-analysis-of-data-from-a-belgian-tertiary-center
#17
Katty Van Cauwenberghe, Ann Raes, Lut Pauwels, Jo Dehoorne, Luc Colenbie, Clement Dequidt, Lien Dossche, Johan Vande Walle, Agnieszka Prytuła
Pediatric renal transplantation with a living donor (LD) has superior outcome, but there is a paucity of studies analyzing the reasons for not undertaking living donation in West-European countries. The aim of this study was to retrospectively review the choice of donor source in our center. We also aimed to identify factors which prevented transplantation with a LD. This retrospective study was performed including children aged 2-19 years who underwent kidney transplantation (KT) at the Ghent University Hospital between 1996 and 2016...
February 4, 2018: Pediatric Transplantation
https://www.readbyqxmd.com/read/29395484/variation-in-dialysis-exposure-prior-to-nonpreemptive-living-donor-kidney-transplantation-in-the-united-states-and-its-association-with-allograft-outcomes
#18
John S Gill, Caren Rose, Yayuk Joffres, David Landsberg, Jagbir Gill
BACKGROUND: The impact of dialysis exposure before nonpreemptive living donor kidney transplantation on allograft outcomes is uncertain. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: Adult first-time recipients of kidney-only living donor transplants in the United States who were recorded within the Scientific Registry of Transplant Recipients for 2000 to 2016. FACTORS: Duration of pretransplantation dialysis exposure...
January 27, 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/29392867/impact-of-center-volume-and-the-adoption-of-laparoscopic-donor-nephrectomy-on-outcomes-in-pediatric-kidney-transplantation
#19
Jennifer M Burg, David L Scott, Kayvan Roayaie, Erin Maynard, John M Barry, C Kristian Enestvedt
Reports for pediatric kidney transplant recipients suggested better outcomes for ODN compared to LDN. Contemporary outcomes stratified by donor type and center volume have not been evaluated in a national dataset. UNOS data (2000-2014) were analyzed for pediatric living donor kidney transplant recipients. The primary outcome was GF; secondary outcomes were DGF, rejection, and patient survival. Live donor nephrectomies for pediatric recipients decreased 30% and transitioned from ODN to LDN. GF rates did not differ for ODN vs LDN (P = ...
February 2, 2018: Pediatric Transplantation
https://www.readbyqxmd.com/read/29392849/risk-of-esrd-in-prior-living-kidney-donors
#20
Jennifer L Wainright, Amanda M Robinson, Amber R Wilk, David K Klassen, Wida S Cherikh, Darren E Stewart
We studied End Stage Renal Disease (ESRD) in living kidney donors (LKDs) who donated in the US between 1994 and 2016 (n=123,526), using Organ Procurement and Transplantation Network and Centers for Medicare and Medicaid Services data. 218 LKDs developed ESRD, with a median of 11.1 years between donation and ESRD. Absolute 20-year risk was low but not uniform, with risk associated with race, age, and sex and increasing exponentially over time. LKDs had increased risk of ESRD if they were male (adjusted Hazard Ratio(aHR): 1...
February 2, 2018: American Journal of Transplantation
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