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Dec 2017 DOI 10.14302/issn.2576-9359.jot-17-1807
J. Schutt RyanCorresponding author
Scripps Center for Organ and Cell Transplantation, Scripps Green Hospital, 10666 North Torrey Road, La Jolla, California
Purpose Intra-operative insults may subject living kidney transplants to poor outcomes. Therefore, we investigated whether intra-operative recipient and donor hemodynamics could act as predictors of delayed graft function and subsequent outcomes. Materials and Methods Living kidney donors and recipients from 2010-2016 at this institution underwent a retrospective chart review. Graft function by post-operative day 7 was used to classify recipients as delayed graft function (need for dialysis), slow graft function (creatinine > 2.5) and good function. Groups were analyzed for intra-operative hemodynamic differences and at one year, incidence of rejection, graft function and survival were compared. Results A total of 111 living renal transplants were performed. Average recipient age was 50 and just over halfwere male (53%). 9% (n=10) and 10% (n=11) developed delayed graft function and slow graft function, respectively. Minimum recipient post re-perfusion central venous pressure ≥12 mmHg was associated with poor graft function (delayed graft function/slow graft function/good function=67%/56%/24%, p=0.009), while intra-operative hypotension (systolic <90 mmHg or diastolic <50 mmHg) was not. Delayed graft function and slow graft function had higher incidences of rejection than good function (30% and 36% vs 9%, p=0.012). Graft function and survival were similar. One patient died with a functioning graft. Conclusions This single center retrospective study suggests that a post re-perfusion central venous pressure ≥12 mmHg is associated with delayed graft function.
Oct 2022 DOI 10.14302/issn.2576-9359.jot-22-4303
Morteza Bagheri SeyedCorresponding author
Department of Radiology, School of medicine, Iran University of Medical Sciences
Background Doppler ultrasonography can evaluate vascular and renal parenchymal disorders. In this study, color Doppler patterns in transplanted kidneys were compared with histological diagnosis to develop diagnostic models for transplanted kidney failure. Method 45 kidney transplant patients participated in this prospective study (16 suffered acute tubular necrosis (ATN), and 29 had transplant rejection). All patients had color-Doppler ultrasonography to measure kidney parameters and Doppler indices. Serum creatinine levels also assessed the transplanted kidney's function. Result Ultrasound showed a significant difference between the two groups in iliac and interlobar PSV. The ROC analysis showed a high diagnostic value of the iliac artery PSV, in distinguishing ATN from kidney transplant rejection. Serum creatinine level correlated directly with transplanted kidney volume, renal cortical thickness, and transplanted kidney length, and inversely with interlobar artery PSV and EDV. In graft rejection patients, the only significant inverse correlation was found between serum creatinine level and PSV of the iliac artery and EDV of the intrelobar artery. Discussion and conclusion The iliac artery PSV can differentiate between ATN and rejection after renal transplantation. Evaluation of renal metric parameters along with PSV and EDV of the interlobar artery (in patients with ATN) and iliac artery and interlobar artery (in transplant rejection) help determine renal dysfunction.
Jun 2017 DOI 10.14302/issn.2576-9359.jot-17-1603
Caprara CarlottaCorresponding author
Department of Nephrology, Dialysis and Transplantation; International Renal Research Institute Vicenza (IRRIV); San Bortolo Hospital; Vicenza.
Single-nucleotide polymorphisms (SNPs) in genes involved in immune responses and in the pharmacokinetics/pharmacodynamics of immunosuppressive drugs influence transplant outcomes of patients receiving the same immunosuppressive therapy. The aim of our preliminary study was to determine the SNPs profiles of ABCB1/MDR-1, UGT1A9, IMPDH2, IL-10 and TNF-α genes associated with acute rejection (AR) events in renal allograft recipients. DNA was extracted from whole blood samples of 220 individuals in 3 experimental groups; Case: 41 kidney transplant patients with AR event(s), Control I: 109 kidney transplant patients without AR event, Control II: 70 healthy blood donors. Acute rejection defined as rapid, unexplained rise in serum creatinine was biopsy-proven. 19 SNPs were analyzed by Sanger Sequencing. Analysis of allele and genotype frequencies and gene-disease association tests were performed. Allele frequencies of healthy persons are in line with ones reported from Europe indicating that the studied population is representative. Statistically significant differences only by the comparison of kidney transplant patients with AR event(s) and healthy individuals are found for rs2032582 and rs1045642 SNPs of ABCB1/MDR1, the latter is also not in Hardy-Weinberg equilibrium in our population. Patients with specific alleles for these SPNs are more prone to have acute rejection events. Certain allele variants of ABCB1/MDR1 by modifying the effectiveness of the drugs may compromise the success of the immunosuppressive therapy and put patients at higher risk to reject the new organ. Therefore screening for these polymorphisms before transplantation would help clinicians to more accurately personalize medications.