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Predictors of graft function and survival in second kidney transplantation: A single center experience

World Journal of Transplantation 2023年第6期13卷 331-343页

作者： Mahmoud Khalil Rabea Ahmed Gadelkareem Medhat Ahmed Abdallah Mohamed Abdel-Basir Sayed FathyGaber Elanany Paolo Fornara Nasreldin Mohammed Department of Urology Assiut Urology and Nephrology HospitalFaculty of MedicineAssiut UniversityAssiut 71515AssiutEgypt Department of Urology and Kidney Transplantation Martin Luther UniversityHalle(Saale)71515Germany

BACKGROUND The increasing kidney retransplantation rate has created a parallel field of research,including the risk factors and outcomes of this advanced form of renal replacement *** presentation of experiences from different kidney transplantation centers may help enrich the literature on kidney retransplantation,as a specific topic in the field of kidney *** To identify the risk factors affecting primary graft function and graft survival rates after second kidney transplantation(SKT).METHODS The records of SKT cases performed between January 1977 and December 2014 at a European tertiary-level kidney transplantation center were retrospectively reviewed and *** the descriptive characteristics,the survivals of patients and both the first and second grafts were described using Kaplan-Meier *** addition,Kaplan-Meier analyses were also used to estimate the survival probabilities at 1,3,5,and 10 post-operative years,as well as at the longest followup duration ***,bivariate associations between various predictors and the categorical outcomes were assessed,using the suitable biostatistical tests,according to the predictor *** Out of 1861 cases of kidney transplantation,only 48 cases with SKT were eligible for studying,including 33 men and 15 women with a mean age of 42.1±13 *** primary non-function(PNF)graft occurred in five patients(10.4%).In bivariate analyses,a high body mass index(P=0.009)and first graft loss due to acute rejection(P=0.025)were the only significant predictors of PNF *** second graft survival was reduced by delayed graft function in the first(P=0.008)and second(Pgraft/patient survival rates at 1,3,5 and 10 years were 90.5%/97.9%,79.9%/95.6%,73.7%/91.9%,and 51.6%/83.0%,respe

关键词： graft failure graft function Kidney Kidney retransplantation Primary non-function graft Second kidney transplantation

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Renal Transplant Artery Stenosis: Clinical Manifestations, Diagnosis and Treatment

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Open Journal of Nephrology 2024年第2期14卷 262-274页

作者： Rihab Dkhissi Latifa Driouch Naima Ouzeddoun Loubna Benamar Tarik Bouattar Department of Nephrology-Dialysis-Renal Transplantation IbnSina Hospital Mohammed V University Rabat Morocco

Introduction: Renal transplant artery stenosis (RTAS) is a common and early complication of renal transplantation, which can lead to severe post-transplant hypertension, as well as significant morbidity and mortality, particulary graft loss. The aim of this study is to determine the prevalence, clinico-radiological characteristics and evaluate the outcomes of luminal angioplasty as a first-line treatment for RTAS, through the analysis of medical records of 27 kidney transplant patients. Material and Methods: This is a retrospective, single-center, and descriptive study conducted at the Nephrology department of the Ibn-Sina Hospital in Rabat, including 27 renal transplant patients with RTAS during the period from 1998 to 2023. All patients with clinically suspected RTAS and confirmed by Doppler ultrasound of the transplanted renal artery were included in the study. Results: The mean age of donors was 48.66 ± 13.55 years, with a female predominance (65%). The donor was deceased in 15% of cases. The mean age of the recipients was 39 ± 16 years with a male-to-female ratio of 4.4. The median onset of RTAS was 3.6 ± 3.4 months after renal transplantation. Seven patients (26%) had high blood pressure (HBP) before their transplantation. Six patients (22%) had hypertriglyceridemia and 7 patients (26%) had pure hypercholesterolemia. The main clinical signs were worsening of preexisting HBP, de novo HBP and acute renal failure (ARF). Stenosis was confirmed by renal Doppler ultrasound in all patients. It was severe in 63%, with a stenosis degree greater than 70%. Six patients underwent angioplasty, resulting in the stabilization of graft function with a nadir of 15 mg/l creatinine and blood pressure control with dual therapy in 5 patients. No graft loss cases were noted. Conclusion: RTAS is a significant vascular complication of renal transplantation that predicts unfavorable outcomes for both the patient and the graft. Early diagnosis is crucial to successfully restore graft f

关键词： RTAS Post Transplant Hypertension graft function Luminal Angioplasty

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Anti-human leukocyte antigens and anti-major histocompatibility complex class I-related chain A antibody expression in kidney transplantation during a four-year follow-up

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Chinese Medical Journal 2013年第15期126卷 2815-2820页

作者： HE Jun LI Chen YUAN Xiao-ni ZHANG Jiang-lei LI Yang WEI Xue-dong HOU Jian-quan Soochow Univ Affiliated Hosp 1 Jiangsu Inst Hematol Suzhou 215006 Jiangsu Peoples R China Soochow Univ Affiliated Hosp 1 Dept Urol Suzhou 215006 Jiangsu Peoples R China Wuxi 2 Peoples Hosp Dept Urol Wuxi 214002 Jiangsu Peoples R China

Background Humoral immunity is an important factor for long-term survival of renal allograft. Here we performed a four-year follow-up to explore the clinical significance of monitoring anti-human leukocyte antigens （HLA） and anti-major histocompatibility complex class I-related chain A （MICA） antibody expression after kidney transplantation. Methods We obtained serial serum samples from 84 kidney transplant patients over a four-year period. All patients were followed up at least 6 months after transplantation and had at least two follow-up points. Anti-HLA and anti-MICA antibody titres and serum creatinine （SCr） levels were evaluated at each follow-up. Patients were divided into 4 groups： HLA（＋） MICA（-）, HLA（-）MICA（＋）, HLA（＋）MICA（＋） and HLA（-）MICA（-）. The impact of post-transplant antibody level on kidney allograft function was evaluated. Results Antibodies were detected in 38.1% （32/84） of the renal allograft recipients. HLA, MICA and HLA＋MICA expression was observed in 18.89%, 14.44% and 5.93% of the recipients respectively. The most frequent anti-HLA and anti-MICA specific antibodies identified were All, A24, A29, A32, A33, A80; B7, B13, B37; DR17, DR12, DR18, DR52, DR53, DR1, DR4, DR9, DR51; DQ7, DQ4, DQ8, DQ2, DQ9, DQ5, DQ6 and MICA02, MICA18, MICA19, MICA07, MICA27. As the time after transplantation elapsed, more recipients developed de novo antibody expression. Total 11.91% （10/84） of the recipients had de novo antibody expression during the follow up. The average level of SCr and the percentage of recipients with abnormal allograft function were significantly higher in recipients with anti-HLA and/or anti- MICA antibody expression than those without. The appearance of anti-HLA and anti-MICA antibody expression always preceded the increase in SCr value. Conclusions Anti-HLA and anti-MICA antibody expression has predictive value for early and late allograft dysfunction. The presence of donor specific antibody is detrimental to graft function and graft survival

关键词： kidney transplantation," human leukocyte antigens," major histocompatibility complex class I-related chain A antibody graft function donor specific antibody non-donor specific antibody

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Monitoring of clinical islet transplantation

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Chinese Medical Journal 2013年第3期126卷 578-585页

作者： HE Si-rong MAI Gang LU Yan-rong CHEN You-nan ZHANG Shuang CHENG Jing-qiu Key Laboratory of Transplantation Engineering and Immunology Ministry of Health Regenerative Medicine Research Center West China Hospital Sichuan University Chengdu Sichuan 610041 China Department of Surgery West China Hospital Sichuan University Chengdu Sichuan 610041 China

Islet transplantation has recently emerged as one of the most promising therapeutic approaches to improving glycometabolic control in diabetic patients. The Edmonton trials demonstrated a marked improvement in the short-term rate of success of islet transplantation, with an 80% rate of insulin-independence being at 1 year after transplantation, as reported by several institutions worldwide. Unfortunately, this rate consistently decreases to 10% by 5 years post-transplantation.

关键词： islet transplantation islet labeling graft function immunological monitoring complications

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Primary graft dysfunction after liver transplantation

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Hepatobiliary & Pancreatic Diseases International 2014年第2期13卷 125-137页

作者： Xiao-Bo Chen Ming-Qing Xu Department of Liver and Vascular Surgery West China Hospital Sichuan University

BACKGROUND: Primary graft dysfunction (PGD) causes complications in liver transplantation, which result in poor prognosis. Recipients who develop PGD usually experience a longer intensive care unit and hospital stay and have higher mortality and graft loss rates compared with those without graft dysfunction. However, because of the lack of universally accepted definition, early diagnosis of graft dysfunction is difficult. Additionally, numerous factors affect the allograft function after transplantation, making the prediction of PGD more difficult. The present review was to analyze the literature available on PGD and to propose a *** SOURCE: A search of PubMed (up to the end of 2012) for English-language articles relevant to PGD was performed to clarify the characteristics, risk factors, and possible treatments or interventions for ***: There is no pathological diagnostic standard; many documented definitions of PGD are different. Many factors such as donor status, procurement and transplant process and recipient illness may affect the function of graft, and ischemia reperfusion injury is considered the direct cause. Potentia managements which are helpful to improve graft function were investigated. Some of them are ***: Our analyses suggested that the definition of PGD should include one or more of the following variables: (1)bilirubin ≥10 mg/dL on postoperative day 7; (2) internationa normalized ratio ≥1.6 on postoperative day 7; and (3) alanine aminotransferase or aspartate aminotransferase >2000 IU/L within 7 postoperative days. Reducing risk factors may decrease the incidence of PGD. A majority of the recipients could recover from PGD; however, when the graft progresses intoprimary non-function, the patients need to be treated with retransplantation.

关键词： graft function primary graft dysfunction initial poor function primary non-function liver transplantation

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Islet cell transplantation as a cure for insulin dependent diabetes: current improvements in preserving islet cell mass and function

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Hepatobiliary & Pancreatic Diseases International 2003年第2期2卷 486-495页

作者： MagaliJ.Fontaine the Department of Pathology and Laboratory Medicine Medical University of South Carolina. Charleston SC 29425 USA

OBJECTIVE: To review the current progress of islet cell transplantation in patients with insulin-dependent diabetes, emphasizing on the difficulties with recovering and preserving islet cell mass and function, 30% of which is lost during the peri-transplantation period. RESULTS: The islet-cell isolation technique is perfected, but improvements are still progressing in two major directions: preservation of islet cells and tolerance induction. Optimum islet cell viability and function depends on appropriate revascularization of the islet graft and blockade of thrombus formation as well as cytokine and free radical release. Conditioning the islet cells in-vitro prior to transplantation to either upregulate VEGF expression or downregulate NF-kappa B transcription factor has proven to improve revascularization and to prevent islet cell apoptosis and cytokine-mediated damage. Tolerance induction is currently being best achieved by selecting and combining immunosuppressive agents such as monoclonal antibodies which target the major signaling molecules during immune activation, but which are least toxic to islet cells. CONCLUSIONS: Patients with insulin-dependent diabetes will greatly benefit from current developments in effective approaches to protect islets during the peritransplant period. Emerging interest in stem cell biology and differentiation may provide the ultimate solution to the problem of organ scarcity and islet cell protection from the peritransplant induced damage.

关键词： islets of Langerhans transplantation graft function graft preservation type I diabetes

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Role for contrast-enhanced ultrasound in assessing complications after kidney transplant

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World Journal of Radiology 2020年第8期12卷 156-171页

作者： Giuseppe Como Jacopo Da Re Gian Luigi Adani Chiara Zuiani Rossano Girometti Institute of Radiology University Hospital S.Maria della MisericordiaUdine 33100Italy Department of Medicine University of UdineUniversity Hospital S.Maria della MisericordiaUdine 33100Italy Department of Medicine General Surgery and TransplantationUniversity Hospital S.Maria della MisericordiaUdine 33100Italy

Kidney transplantation(KT)is an effective treatment for end-stage renal *** their rate has reduced over time,post-transplant complications still represent a major clinical problem because of the associated risk of graft failure and ***,post-KT complications should be diagnosed and treated *** plays a pivotal role in this *** ultrasound(US)with color Doppler analysis is the first-line imaging modality for assessing complications,although many findings lack *** performed by experienced operators,contrast-enhanced US(CEUS)has been advocated as a safe and fast tool to improve the accuracy of ***,when performing CEUS there is potentially no need for further imaging,such as contrast-enhanced computed tomography or magnetic resonance imaging,which are often contraindicated in recipients with impaired renal *** technique is also portable to patients’bedside,thus having the potential of maximizing the cost-effectiveness of the whole diagnostic ***,the use of blood-pool contrast agents allows translating information on graft microvasculature into time-intensity curves,and in turn quantitative perfusion *** analysis is under evaluation as a tool to diagnose rejection or other causes of graft *** this paper,we review and illustrate the indications to CEUS in the post-KT setting,as well as the main CEUS findings that can help establishing the diagnosis and planning the most adequate treatment.

关键词： Contrast-enhanced ultrasound Kidney transplant Post-renal transplant complications graft function Ultrasound contrast agents

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