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Background:
Long-term function of transplanted kidney is the factor determining quality of life for transplant recipients. The aim of this study was to evaluate the effect of selected factors on time of graft function after renal transplantation within 15 years of observation.
Methods:
Preoperative and intraoperative factors were analyzed in 232...
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Context 1
... rate was 46.9%, with accurate graft function at day 180 in 92% of recipients. Study population characteristics are presented in Table 1. A univariate Cox regression proportional hazards model showed a statistically significant relationship between DGF, acute rejection, and serum creatinine level in the post- operative period and long-term graft function, as presented in Table 2. ...
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Background:
Recent changes in policies guiding allocation of transplant kidneys are predicted to increase sharing between distant geographic regions. The potential exists for an increase in cold ischemia time (CIT) with resulting increases in delayed graft function (DGF) and transplant-related costs (TRC). We sought to explore the impact of CIT on...
Delayed graft function (DGF) after kidney transplantation is not uncommon, and it is associated with long-term allograft impairment. Our aim was to compare renal perfusion changes measured with non-invasive functional MRI in patients early after kidney transplantation to renal function and allograft histology in biopsy samples. Forty-six patients u...
Ischemia-reperfusion injury (IRI) constitutes a significant source of morbidity and mortality after orthotopic liver transplantation (OLT). The allograft is metabolically impaired during warm and cold ischemia and is further damaged by a paradox reperfusion injury after revascularization and reoxygenation. Short-term and long-term complications inc...
Background/aims:
Delayed graft function (DGF) is associated with adverse outcomes after renal transplantation. Bone morphogenetic protein-2 (BMP-2) is involved in both endothelial function and immunological events. We compared expression of BMP-2 in epigastric artery of renal transplant recipients with immediate graft function (IGF) and DGF.
Meth...
Citations
... Most of the times, kidney transplantation is the best treatment option for those with ESRD. Successful transplantation for these patients ensures much greater survival chances and a higher quality of life compared with dialysis (2). Immunosuppression, concurrent diseases such as diabetes, urinary reflux disease, and elderly age make kidney transplant recipients particularly prone to infections (3). ...
Background: End-stage renal disease (ESRD) needs replacement therapy and most often, kidney transplantation is the best therapeutic option. Urinary tract infection (UTI) is one of the most important complications after renal transplantation that affects transplantation outcomes. Objectives: This study aimed to define the incidence rate, UTI risk factors among kidney transplant recipients, and causative organism of UTI and their antibiotic susceptibility. Methods: In this cross-sectional study, we collected clinical, demographic, and laboratory data from 268 transplant recipients in Ali-Asghar Hospital from 2011 - 2018. Data collected from patients were analyzed with SPSS software version 25. Results: According to the results, 50 (18.7%) had UTI in the first year after renal transplantation. Female gender and underlying cause of renal failure were predisposing factors for UTI. The most common causative organism was Escherichia coli (58.4%). The antibiotic susceptibility results showed nitrofurantoin and meropenem as the most effective antibiotics for Escherichia coli. Conclusions: The UTI was more common in women and patients with analgesic nephropathy and lupus nephritis. The most common causative organism was E. coli and meropenem and nitrofurantoin were the most effective drug choices.
... Several studies have shown SCr as a predictor of long-term outcomes. 3,4,7,[11][12][13][14][15] The level of SCr at discharge from hospital has been shown to be a predictor of long-term renal graft outcome. 3 SCr at 90 days after transplant is a predication factor of late graft dysfunction. ...
... 3 SCr at 90 days after transplant is a predication factor of late graft dysfunction. 4 Donor age has been shown to be a predictor of long-term outcome. [16][17][18] Interesting observation in our study was the fact that the mean donor age in Group G4 (SCr ≥176.9 µmol/L) was 42.07 ± 10.49 as compared to G1 (SCr ≤88.4 µmol/L) of 30.10 ± 8.54 years (P <0.001). ...
This study was carried out to determine the impact of one-year posttransplant serum creatinine (SCr) levels on the long-term outcomes of living-related donor kidney transplants. A retrospective cohort study included 773 adult living-related renal transplant recipients from 2010 to 2012, with a minimum follow-up period of five years. Demographics and posttransplantation follow-up data including immunosuppression regimens, rejection episodes, and survival rates were evaluated. Patients were divided into four cohorts (G1, G2, G3, and G4 based on SCr at the end of the 1st year: G1, SCr <88.4 μ mol/L; G2, 88.5≤ SCr ≤ 132.6 μmol/L; G3, 132.7≤ SCr ≤176.8 mol/L; and G4, SCr ≥176.9 μ mol/L). Comparisons between the groups used the Chi-square test for qualitative parameters and analysis of variance for continuous variables. Five-year graft survival for G1 was 98% as compared to 76% in G4 (P <0.001). Recipients of G4 encountered more acute rejection episodes in 21% of the cases as compared to 7.3% in G1 (P = 0.001). Donors were older in G4 (42.07 ± 10.4 years) as compared to G1 (30.1 ± 8.5 years) (P = 0.001). A third of the donors in G1 were HLA identical as compared to 7% in G4. Prediction of long-term graft survival is possible by the SCr level at one year post transplant. This can be of great importance, especially to identify those patients who require close monitoring in follow-up. Donor age, HLA, and acute rejection impact SCr at one year and hence graft outcome.
... The incidence and prevalence of end-stage kidney disease (ESKD) have significantly increased in developing countries, such as South Africa (1). Patients with ESKD have an increased risk of premature death on chronic dialysis therapy and for long term survival, kidney transplantation is the treatment of choice (2). A successful kidney transplant increases the life-expectancy and quality of life of a patient with ESKD. ...
Objectives: Patients' characteristics that could influence graft survival may also exhibit non-constant effects over time; therefore, violating the important assumption of the Cox proportional hazard (PH) model. We describe the effects of covariates on the hazard of graft failure in the presence of long follow-ups.
Study Design and Settings: We studied 915 adult patients that received kidney transplant between 1984 and 2000, using Cox PH, a variation of the Aalen additive hazard and Accelerated failure time (AFT) models. Selection of important predictors was based on the purposeful method of variable selection.
Results: Out of 915 patients under study, 43% had graft failure by the end of the study. The graft survival rate is 81, 66, and 50% at 1, 5, and 10 years, respectively. Our models indicate that donor type, recipient age, donor-recipient gender match, delayed graft function, diabetes and recipient ethnicity are significant predictors of graft survival. However, only the recipient age and donor-recipient gender match exhibit constant effects in the models.
Conclusion: Conclusion made about predictors of graft survival in the Cox PH model without adequate assessment of the model fit could over-estimate significant effects. The additive hazard and AFT models offer more flexibility in understanding covariates with non-constant effects on graft survival. Our results suggest that the period of follow-up in this study is long to support the proportionality assumption. Modeling graft survival at different time points may restrain the possibility of important covariates showing time-variant effects in the Cox PH model.
... Detailed characteristics of included studies are presented in Table 1. Among these studies, 18 studies provided multivariable-adjusted effect estimates [19,[21][22][23][24][27][28][29][30][31][32][33][34][35][36][37][38][39], 3 studies provided both multivariable-adjusted and univariable-unadjusted data [20,25,26], and 2 studies provided univariable-unadjusted data [40,41]. Besides, 8 studies were multi-centered [19,23,27,32,33,35,37,38]; another 15 studies were single-centered [20-22, 24-26, 28-31, 34, 36, 39-41]. ...
Background:
The magnitude effects of human leukocyte antigen (HLA) mismatching on post-transplant outcomes of kidney transplantation remain controversial. We aim to quantitatively assess the associations of HLA mismatching with graft survival and mortality in adult kidney transplantation.
Methods:
We searched PubMed, EMBASE and the Cochrane Library from their inception to December, 2016. Priori clinical outcomes were overall graft failure, death-censored graft failure and all-cause mortality.
Results:
A total of 23 cohort studies covering 486,608 recipients were selected. HLA per mismatch was significant associated with increased risks of overall graft failure (hazard ratio (HR), 1.06; 95% confidence interval (CI), 1.05-1.07), death-censored graft failure (HR: 1.09; 95% CI 1.06-1.12) and all-cause mortality (HR: 1.04; 95% CI: 1.02-1.07). Besides, HLA-DR mismatches were significant associated with worse overall graft survival (HR: 1.12, 95% CI: 1.05-1.21). For HLA-A locus, the association was insignificant (HR: 1.06; 95% CI: 0.98-1.14). We observed no significant association between HLA-B locus and overall graft failure (HR: 1.01; 95% CI: 0.90-1.15). In subgroup analyses, we found recipient sample size and ethnicity maybe the potential sources of heterogeneity.
Conclusions:
HLA mismatching was still a critical prognostic factor that affects graft and recipient survival. HLA-DR mismatching has a substantial impact on recipient's graft survival. HLA-A mismatching has minor but insignificant impact on graft survival outcomes.
Data binding the expression of Toll-like 4 receptor (TLR4ex), transplanted kidney function, and the cause of pre-transplant end-stage renal disease are scarcely available.
Objective
To investigate the relationship between pre-transplant chronic interstitial nephritis (CIN), TLR4ex and transplanted kidney function.
Materials and methods
TLR4ex was measured in peripheral blood mononuclear cells of 43 CIN kidney transplant recipients. We compared TLR4ex among 33 patients with pre-transplant chronic non-infectious interstitial nephritis (NIN) and 10 patients with pre-transplant chronic pyelonephritis (Py). At the beginning (Day-0) TLR4ex, as well as concentrations of cyclosporin A (CyA) and tacrolimus (TAC) were determined. Both CIN and NIN patients were divided according to the respective median of TLR4ex into groups of low-TLR4 expression (L-TLR4ex) and high-TLR4 expression (H-TLR4ex). Serum creatinine/glomerular filtration rate (sCr/EGFR) was assessed on Day-0 and after the follow-up (F-up). The magnitudes of sCr/EGFR change (ΔsCr/ΔEGFR) were evaluated. The treatment was maintained stable along the F-up period (median 11.9 months).
Results
Day-0: in CIN with L-TLR4ex TAC was lower but sCr/EGFR were not different from H-TLR4ex; in Py TLR4ex and TAC were lower than in NIN with no difference in sCR/eGFR. After F-up: in CIN with L-TLR4ex sCR/EGFR and ΔsCr/ΔEGFR were worse than in H-TLR4ex; in Py sCR/EGFR and ΔsCr/ΔEGFR were worse than in NIN. The regression analysis points out prospective impact of Py and TLR4ex on sCR/eGFR and ΔsCr/ΔeGFR.
Conclusion
In CIN, both TLR4ex and Tac appear to be a useful positive predictor of the effectiveness of immunosuppression. Chronic pyelonephritis indirectly promotes faster progression of chronic transplanted kidney disease.
Background:
Short- and intermediate-term results have been reported after rapid discontinuation of prednisone (RDP) in kidney transplant recipients. Yet there has been residual concern about late graft failure in the absence of maintenance prednisone.
Methods:
From October 1, 1999, through June 1, 2015, we performed a total of 1553 adult 1st and 2nd kidney transplants-1021 with a living donor (LD), 532 with a deceased donor (DD)-under our RDP protocol. We analyzed the 15-year actuarial overall patient survival (PS), graft survival (GS), death-censored graft survival (DCGS), and acute rejection-free survival (ARFS) rates for RDP compared to historical controls on maintenance prednisone.
Results:
For LD recipients, the actuarial 15-year PS rates were similar between groups. But RDP was associated with increased GS (p=0.02) and DCGS (p=0.01). For DD recipients, RDP was associated with significantly better PS (p<0.01), GS (p<0.01) and DCGS (p<0.01). There was no difference between groups in the rate of acute or chronic rejection, or in the mean estimated glomerular filtration rate at 15 years. However, RDP-treated recipients had significantly lower rates of avascular necrosis, CMV, cataracts, NODAT and cardiac complications. Importantly, for recipients with graft survival >5 years, there was no difference between groups in subsequent actuarial PS, GS, and DCGS.
Conclusion:
In summary, at 15-years post kidney transplant, RDP did not lead to decreased in patient or graft survival, or an increase in graft dysfunction but as associated with reduced complication rates.
Kidney surface cooling was used during implantation to assess the effect of warm ischemia elimination on allograft function, histological changes and immune-related gene expression. 23 recipients were randomly assigned to a group operated on with kidney surface cooling during implantation (ice bag technique, IBT group), and the other 23 recipients receiving the contralateral kidney from the same donor were operated on with a standard technique. Three consecutive kidney core biopsies were obtained during the transplantation procedure: after organ recovery, after cold ischemia and after reperfusion. Gene expression levels were determined using low-density arrays (Format 32, TaqMan). The IBT group showed a significantly lower rate of detrimental events (delayed graft function and/or acute rejection, p = 0.015) as well as higher glomerular filtration rate on day 14 (p = 0.026). A greater decrease of MMP9 and LCN2 gene expression was seen in the IBT group during total ischemia (p = 0.003 and p = 0.018). Elimination of second warm ischemia reduced the number of detrimental events after kidney transplantation, and thus had influence on the short-term but not long-term allograft function. Surface cooling of the kidney during vascular anastomosis may reduce some detrimental effects of immune activation resulting from both brain death and ischemia-reperfusion injury.
