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Open access

Bernadetta Kałuża, Ireneusz Ziobrowski and Marek Durlik

Surgical Procedures Not Connected with Transplantation in Patients After Kidney or Kidney and Pancreas Transplant with Stable Function of Graft

The aim of the study was to evaluate complication during and after surgical procedure without connection with transplantation among patients after kidney, kidney and pancreas transplantation with stable function of graft.

Material and methods. 54 patients underwent 62 surgical procedures without connection with transplantation procedure. Main characteristic: standard immunosuppressive treatment, main age 51.1±13.95 years, men 77.4%, hospitalization time 5.27±3.31 day, group 1 - 55 procedures among patients after kidney transplantation, group 2 - 7 procedure among patients after kidney and pancreas transplantation.

Results. Procedures from general surgery comprised 60% [cholecystectomy 19 (51%), left hemicolectomy 1 (3%), esophagus removal 1 (3%), hernia repair 8 (22%), nefrectomy 3 (8%), pancreas transplantation in patients with functional renal graft 1 (3%), laparotomy 4 (11%), vascular surgery 27% (correction of arteriovenosus fistula 13 (76%), by-pass surgery 1 (6%), embolectomy 1 (6%), implantation of aortal - iliac stentgraft 1 (6%), surgery of iliac artery 1 (6%)]. There has been no difference between parameters measured before and after procedure: creatinine (p=0.93), GFR (p=0.07), urea (p=0.25), glycaemia (p=0.322), glycated hemoglobin (p=0.3), C-peptide (p=0.3). In both groups were no differences in levels of creatinine (p=0.78) and urea (p=0.23), measured in the next years after surgical procedure. Mortality 0%, lost of graft 0%, in - hospital morbidity 10 (16.2%) (hematoma 1.6%, endocavitary electrode 1.6%, wound healing defect 16.2%). Morbidity in group 1 - 12.7%, group 2 - 48.8%, p=0.04.

Conclusions. Surgical procedures performed in a specialist center do not impaire prognosis of patients with stable function of graft, after kidney, kidney and pancreas transplantation.

Open access

Klinta Gritane, Janis Jusinkis, Aleksandrs Malcevs, Vadims Suhorukovs, Diana Amerika and Ieva Ziedina

Abstract

Introduction. In 2014, new scoring system - Kidney Donor Profile Index (KDPI) was introduced. KDPI is a numerical measure that combines ten donor factors, including clinical parameters and demographics, to summarize into a single number the quality of deceased donor kidneys. There are some publications regarding usefulness of KDPI in the first kidney transplant recipients, however there are no data focusing on repeated transplantation patients. Aim of the Study. To determine the usefulness of kidney donor profile index as a risk marker of graft failure in repeated transplantation situations. Material and methods. A single-centre retrospective study was conducted. Patients who underwent a repeated transplantation from deceased donors between 2005. and 2013. were included in the study. Data about donor’s risk factors - age, height, weight, race, history of hypertension, history of diabetes, cause of death, serum creatinine, anti-HCV and if donor is after cardiac death - were collected and KDPI was calculated for all participants. Patients were divided into groups according to determined KDPI: Group 1 - KDPI <35%; Group 2 - KDPI 36 - 69%; Group 3 - KDPI >70%. For statistical analysis, IBM Statistical Package for the Social Sciences, version 21.0 was used. Results. A total of 72 patients were enrolled in the study. There were 17 patients (23.6%) in the 1. group, 38 patients (52.8%) in the 2. group and 17 patients (23.6%) in the 3. group. The most common cause of an end stage renal disease was chronic glomerulonephritis- 59.7% (n=43). Patients with higher KDPI developed acute rejection more often. In the group with KDPI <35% it was observed in 35.3%, while in the groups with KDPI 36 - 69% and KDPI >70% in 60.5% and 64.7% of patients, p = 0.02. Graft function differed significantly both, after one (p =0.01) and three years (p=0.04) with the highest eGFR results in the group with the lowest KDPI. The difference in graft survival rates was statistically significant, p = 0.027. After three- years it was 88.2% in the first group, 86.8% in the second group and 70.6% in the third group. Patient survival rates showed trend toward significance (p = 0.076) with only two patients lost during three- year follow up. Conclusions. KDPI presents relevance with repeated transplantation outcomes. Lower KDPI indicates better transplantation outcomes - superior graft function and better graft survival. However, there is only trend towards significance in patient survival rates.

Open access

Aleksandr Maltsev, Janis Jushinskis and Rafails Rozentals

The Use of Deceased Donors for Kidneys Transplantations

Introduction. The lack of donor organs aimed at transplanting is a great problem all over the world. To solve the problem the criteria of selecting donors progressively expand including donors after cardiac death. Analysis performed in this report refers to the use of donors after the controlled cardiac death to transplant kidneys at the Latvian transplantation center.

Aim of the study. To clarify the renal transplant outcomes after transplantation from deceased donors of two types - donors after cardiac death and donors after brain death.

Materials and methods. Study included 351 consecutive primary renal transplantations from deceased donors procured in a single transplant center during the period since 2000 till 2005. Kidneys were recovered from 244 deceased donors at the age of 41.2 + 13.2 (8 - 68): from 68 - after cardiac death (DCD) and from 176 - after stating the brain death (DBD), (control group). Results of transplantations were compared regarding the type of deceased donors been used.

Results. The percentage of non functioning graft recovered from donors after cardiac death made up 1.8 % (at the rate of 1.6 % in a control group). Delayed graft function of transplants made up respectively 14.0% and 12.3%. Within a period of 5 years mortality in DCD group made up 15 % and in BDB group 12.3 %. Graft survival was respectively 76.7 % and 84.8% (p = 0,046).

Conclusion. Results of study show the efficiency of transplanting kidneys received from donors after cardiac death and brain death. Long term results in DCD donation should be improved by introduction of new technologies.

Open access

I Dedinska, L Laca, J Miklusica, J Ulianko, J Janek, P Galajda, M Stancik, M Cellar and M Mokan

Abstract

Purpose: Cigarette smoking has adverse effects on kidney transplant recipients, causing cardiovascular disease, kidney function impairment, and cancer. New onset diabetes mellitus after transplantation (NODAT) represents serious complication of transplantation of solid organs.

Methods: In the group of 252 patients after kidney transplantation, we identified smokers and current non-smokers (the patient who has not been smoking or who is ex smoker) for the period of minimum 24 months. In the monitored period of 12 months after transplantation, we detected presence of NODAT in both groups. The group contained only those patients who did not have diabetes mellitus (of type 1 and 2) at the time of kidney transplantation.

Results: The group of smokers was composed of 88 patients (34.9 %) and non-smokers 164 patients (65.1 %). The average age of smokers was 52 years ± 12.4, and of current non-smokers it was 44.8 years ± 12.8 (P < 0.0001). The smokers had significantly lower body mass index (BMI) at the time of kidney transplantation (P = 0.0059) and also 12 months after transplantation (P = 0.0069), lower weight gain 12 months after transplantation (P = 0.0220) and larger waist circumference 12 months after transplantation (P < 0.0001).

Conclusion: In our group, smoking had no effect on development of NODAT, the smokers had lower values of BMI and waist circumference, however, the guideline development group feels that, as for the general population, success of smoking cessation can be enhanced by offering structured smoking cessation programs.

Open access

L Kovacikova, L Bena, E Lackova, Z Zilinska, K Granak, P Skalova, M Vnucak, L Laca, M Mokan and I. Dedinska

Abstract

Background: Chronic kidney disease represents a world-wide health problem affecting approximately 195 million women around the world. Risk of development of chronic kidney disease is greater in women; therefore, the World Kidney Day 2018 was dedicated to kidney disease, treatment options, and its specifics in female patients.

Materials and Methods: We retrospectively analysed a cohort of 1,457 patients after kidney transplantation from all transplant centres in Slovakia over a period of ten years from 2005 – 2015.The parameters taken into account were cause of end-stage renal disease (ESRD), outcome of transplantation in a context of differences between the genders.

Results: During the ten-year period there were 557 transplanted women vs. 900 men. Among female recipient the dominant cause of ESRD was tubulointerstitial nephritis (males 22.3% vs. females 32.1%, p < 0.0001), other causes of ESRD where females were significantly more represented than men included polycystic kidney disease (males 11.6% vs. females 17.6%, p = 0.0013) and systemic lupus erythematosus (males 0.2% vs. females 2.3 %, p = 0.0001). There was no significant difference in 12-month, 5-year, and 10-year both graft and patient survival rates between men and women. Female recipients wait for kidney transplantation significantly longer in spite of comparable time spent on dialysis (males 32.9 months vs. females 39.4 months, p < 0.0001).

Conclusion: Despite comparable patient and graft survival rates in male and female recipients in our study there are other studies showing that gender as well as gender mismatch significantly influence the outcomes of transplantation.

Open access

Maciej Głyda, Wojciech Czapiewski, Marek Karczewski, Renata Pięta and Andrzej Oko

Influence of Donor and Recipient Gender as well as Selected Factors on the Five-Year Survival of Kidney Graft

The aim of the study was to determine the impact of the gender of renal allograft donor and recipient on the graft function over a 5-year follow-up period.

Material and methods. The 154 kidney grafts from 77 donors transplanted into recipients of both genders. Two study groups were formed: one group consisted of male donors, while the other consisted of female donors. The recipients in each of the groups consisted of a pair, one male and one female.

Results. 71% of grafts survived the five-year period in the group of male and female recipients when the donor was male; in case of female donors, the rate was 62.5%. Depending on the gender of the donor and the recipient, the rates of grafts with five-year survival were as follows: 79.2% for male donors and female recipients (MF); 62.5% for male donors and male recipients (MM). The difference between both groups was not statistically significant. In the case of female donors and male recipients (FM), the five-year survival rate was 58.3%, while in female donors and female recipients, the five-year survival rate was 64.1%.

Conclusions. Grafts from male donors show a trend towards better five-year survival compared to grafts from female donors. The highest five-year survival rate was observed when the donor was male and the recipient was female; the lowest rate was observed for female donors and male recipients.

Open access

Mirela Jozicic, Alen Imsirovic, Lea Katalinic, Branimir Krtalic and Nikolina Basic Jukic

Abstract

Introduction. Although the incidence of malignancy has increased after solid organ transplantation, data on lung cancer in this group of patients is scarce. The aim of this study was to determine clinical characteristics and outcome of patients who developed lung cancer after renal transplantation. Methods. Among a cohort of 1658 patients who received a transplant at our institution and were followedup between 1973 and 2014, five patients developed lung cancer. We analyzed risk factors, transplantation characteristics, treatment options and survival. Results. Lung cancer was diagnosed in 5 patients (0.3%). Time to diagnosis after the transplant procedure ranged from 26 to 156 months (mean 115 months). All of them had a smoking history. Tumors were classified as IIB (20%), IIIA (40%), and IV (40%). Histological types included adenocarcinoma (80%) and there was one case of sarcomatoid carcinoma (20%). One patient had concomitant thyroid papillary carcinoma. Radiotherapy was applied in 2 patients, 2 underwent chemotherapy (erlotinib and combination of carboplatinum and etopozide in one patient each), and 2 died within one month after the diagnosis from disseminated malignant disease. Patients with stage IIIA survived 14 and 24 months after the diagnosis. The patient with sarcomatoid cancer underwent thoracotomy with a complete resection, lost his graft function and died 7 months after the diagnosis. Conclusion. Lung cancer is relatively rare malignancy in renal transplant recipients, but associated with high mortality. Smoking is a significant risk factor, thus smoking cessation should be promoted among renal transplant recipients, as well as regular screening for lung cancer.

Open access

Vadims Suhorukovs and Tatjana Tihomirova

The role of biopsy in differential diagnostics of kidney graft pathology

Introduction. Different pathological changes of kidney transplants have similar symptoms, thus differential diagnostic is sometime difficult. The important information that may help to set correct diagnose can be obtained from the kidney transplant biopsy followed by pathohistological investigation.

Aim of the study. The aim of this study is to demonstrate the role of biopsy in differential diagnostics of kidney graft pathology.

Materials and methods. 109 kidney graft biopsies were performed at the Latvian Transplantation Centre in 2007: 20 were protocol biopsies and 89 were performed according to indications (graft dysfunction). All biopsies were performed under USS control followed by pathohistological investigations of the material obtained. Morphological changes were evaluated accordingly to the Banff 97 classification.

Results. The morphological findings were as follows: borderline changes - 8 cases (7.34%); acute cellular rejection - 80 cases (73.4%); acute humoral rejection - 1 case (0,92%); hronic graft nephropathy - 27 cases (24.8%); tubolointersticial nephritis - 36 cases (33%); apostematous nephritis - 1 case (0.92%). We observed mild hematuria in only 2 patients after biopsy which stopped spontaneously in a few days.

Conclusions. Kidney graft biopsy followed by pathohistological investigation of the material obtained is a precise and sensitive method in the diagnostic process of pathological changes of the graft with a small rate of complication.

Open access

Marcin Słojewski, Tomasz Śluzar, Marek Umiński and Andrzej Sikorski

Laparoscopic Live-Donor Nephrectomy With Retroperitoneoscopic Access

Live donation remains the single most consistent factor affecting long-term results of the transplantation. Open live donor nephrectomy is associated with high traumatization and possibility of complications due to large skin incision. The alternative is laparoscopic live donor nephrectomy (LDN) which is widely used in many countries. We present the case of LDN. The retroperitoneal approach was applied and time of operation was 210 min. The immediate function of transplanted kidney was observed. Authors hope that the offering this minimally invasive procedure to the potential donors may popularize the idea of live donation in Poland.

Open access

Amin R. Soliman, Hoda A. Maamoun, Mahmoud A. Soliman, Hatem Darwish and Esam Elbanna

Abstract

Background. Persistent hyperparathyroidism (HPT) with hypercalcemia is prevalent after transplant and is considered a risk factor for progressive bone loss and fractures and vascular calcification, as well as the development of tubulointerstitial calcifications of renal allografts and graft dysfunction. The subtotal parathyroidectomy is the standard treatment, although currently it has been replaced by the calcimimetic cinacalcet.

Aim. The hypothesis of this study is that subtotal parathyroidectomy is superior to cinacalcet for treatment of persistent secondary parathyroidectomy post renal transplant, with minimal morbidity and significantly it reduces the cost of treatment after transplantation.

Methods. We report our long-term clinical experience with either cinacalcet or parathyroidectomy in 59 kidney transplant recipients with hyperparathyroidism. Group one included medical treatment with cinacalcet and had 45 patients while parathyroidectomy patients (group 2) were 16 patients with two of them excluded because of surgical failure.

Results. No difference was found between groups for any parameter. A greater short-term change of calcium and phosphorus homeostasis obtained by surgery than by cinacalcet, and in long term change, no significant difference between the two groups.

Conclusions: The main findings of this study are that correction of severe hyperparathyroidism was similar in both surgical and cinacalcet groups with the absence of a difference of long-term serum iPTH 1-84 levels between the two groups.