Category Archives: Transplant
Chronic Kidney Disease After Liver Transplantation: Pretransplantation Risk Factors and Predictors During Follow-Up
Hemodialysis.com eInterview with Prof Manuela Merli
Dott. Michela Giusto
Dept of Clinical Medicine
Sapienza University of Rome Italy
Hemodialysis.com: What are the main findings of the study?
Prof Merli: The increasing number of long-term survivors of liver transplant raises the question of increased number of patients developing chronic kidney disease (CKD) and end-stage-renal diseases after the transplant. Despite the wide recognition of the multifactorial etiology of post-liver transplant renal dysfunction, a validated predictive score for CKD after liver transplant is still lacking. For this reason we chose to perform a time dependent multivariate analysis. This type of analysis is the best way of taking into account the predictive value of factors occurring during follow-up, and at the same time of considering the changes that may occur in the variables already available at the time of transplantation. We define CKD as estimated GFR<60ml/min in two subsequent controls that were at least 3 month apart, according to the position statement from the Kidney Disease Improving Global Outcome. This cut-off identifies patients with at least a moderate CKD which are those in whom early recognition is important to avoid further nephrotoxic insults.
Marie Benz, MD on Google+Recipient-related predictors of kidney transplantation outcomes in the elderly
Hemodialysis.com Author’s Interview with:
Dr. Kalantar-Zadeh, MD, MPH, PhD
Professor & Chief, Division of Nephrology & Hypertension
University of California Irvine, School of Medicine
Adjunct Professor of Epidemiology, Dept. Epidemiology,
UCLA Fielding School of Public Health, Los Angeles, CA
Parta Hatamizadeh, M.D.
Nephrology Fellow
University of Michigan
Hemodialysis.com: What are the main findings of the study?
Answer: One of the major findings of this study was that the increase in all-cause mortality with advancing age was dramatically attenuated in kidney transplant recipients compared to the general population. The other finding was that among the senior patients (>65 year old) kidney transplant outcome was better in the older recipients compared to the younger seniors and was the best in those older than75 years. Among senior kidney transplant recipients, diabetes had a negative effect on patient survival in all patients but a negative effect on graft survival only in those between 65 and <70 years of age. Female senior recipients generally survived better than their male counterparts but their transplanted kidneys survived less. Obesity was associated with higher graft failure in the the recipients between 65 and70 years old and finally, in the very old recipients (>75 years), Hispanics had the best outcomes.
Demographic, metabolic, and blood pressure characteristics of living kidney donors spanning five decades.
Hemodialysis.com Author Interview with Sandra J. Taler, M.D.
Consultant, Division of Nephrology/Hypertension
Associate Professor of Medicine | College of Medicine |
Mayo Clinic | 200 First Street SW | Rochester, MN 55905
Hemodialysis.com: What are the main findings of the study?
Dr. Taler: We reviewed the medical records of all living kidney donors (8951 total) from 3 large transplant centers (Mayo Clinic, University of Alabama in Birmingham and University of Minnesota) since the beginning of living donation in 1963 through 2007.
We examined trends in the metabolic profile of accepted living donors by quartiles of this 44 year timespan. We saw a trend to higher donor age with fewer donors in their 20s but only 4% of donors were older than age 60 years at the time of donation. Using a consistent definition for hypertension, we found the percentage of donors with hypertension remained low and was stable over time. We did find an increasing proportion of donors were obese or had glucose intolerance in the more recent time quartiles however most had mild elevations in glucose that met acceptance criteria. There was greater tolerance for one or more metabolic abnormalities in older donors but the percentage of older donor remained quite low.
Single Pediatric Kidney Transplantation in Adult Recipients: Comparable Outcomes With Standard-Criteria Deceased Donor Kidney Transplantation
Hemodialysis.com Interview with: Dr Amit Sharma MD. MPhil
Assistant Professor
Director, Transplant Surgery Fellowship Program
Hume-Lee Transplant Center
Virginia Commonwealth University Richmond, Virginia, USA
Hemodialysis.com: What are the main findings of the study?
Dr. Sharma: Single pediatric kidney transplantation (SKT) in to adult recipients has traditionally been considered high risk due to concerns of technical complications leading to poor graft outcomes. As a result many transplant centers hesitate to utilize these kidneys for transplantation. We retrospectively compared outcomes in adult recipients after SKT (n=31), standard criteria deceased donor kidney transplantation (SCDKT, n=283), pediatric en bloc, (EBKT, n=21), living donor (LDKT, n=275) and extended criteria donor, (ECD, n=100) kidney transplantation.
Modifiable Patient Characteristics and Racial Disparities in Evaluation Completion and Living Donor Transplant
Hemodialysis.com Interview with: Dr. Amy D. Waterman
General Medical Sciences, Washington University School of Medicine
Campus Box 8005, 660 S. Euclid Avenue, St. Louis, MO 6311
Hemodialysis.com: What are the main findings of the study?
Dr. Waterman:
- In an analysis of 695 Black and White patients in kidney failure who presented for transplant and were followed over 6 years, Black patients initially presented for evaluation having received less transplant education, being less knowledgeable about transplantation, and less willing to pursue deceased or living donor transplantation than Whites.
- Patients who began their transplant evaluation process with a greater knowledge of transplantation and greater motivation to receive living donor transplants were ultimately more successful at receiving a living donor transplant six year later.
Value of Myocardial Perfusion Imaging in Renal Transplant Evaluation
Interview with: Dr. Chong Ghee Chew
Department of Nuclear Medicine, PET and Bone Mineral Densitometry, Royal Adelaide Hospital, Adelaide, SA
Angina.com: What are the main findings of the study?
Answer: This is a retrospective audit of the cardiac outcomes of renal failure patients who had been transplanted in South Australia between 1999 to 2009, who had myocardial perfusion SPECT scan for the transplant assessment. The results represent ”real world” outcomes as the scans were performed in the 3 major teaching hospitals in SA. 2 endpoints – “soft” = inpatient care with angina +/- PCI +/- CABG, and “hard” = inpatient care with myocardial infarction or cardiac death. With a negative scan this cohort had a statistically significant lower soft endpoint event rate than a positive scan …3.9% vs 20.8%, hazard ratio of 4.4 at 5 years post scan. The hard endpoint event rate was also lower for those with a negative scan but the difference did not reach statistical significance. The event rates of hard and soft endpoints were no different for the negative scans that were performed with a tachycardic stress (treadmill exercise, dobutamine or external wire right atrial pacing) versus dipyridamole induced coronary vasodilatation.
Effect of donor age and cold storage time on outcome in recipients of kidneys donated after circulatory death in the UK
Hemodialysis.com Author Interview: Dr. Dominic Summers MBBChir
Department of Surgery, School of Clinical Medicine
University of Cambridge, Cambridge, UK
Hemodialysis.com: What are the main findings of the study?
Dr. Summers:
Firstly, we were able to confirm our (and others) previous work that showed that there seems to be very little difference in survival and graft function of kidneys from donation after circulatory death (DCD) and kidneys from donation after brain death (DBD).
Secondly, we were able to show that, while kidneys from older donors perform less well than kidneys from younger donors, there is no evidence that this is a particular problem for DCD donor kidneys.
Finally, we showed that DCD donor kidneys are more susceptible to cold ischemic injury.
The Impact of Deceased Donor Kidney Risk Significantly Varies by Recipient Characteristics
Hemodialysis.com Author Interview:
Jesse D. Schold, PhD
Associate Staff in the Department of Quantitative Health Sciences and
Director of Outcomes Research for the Kidney Transplant Program
Cleveland Clinic, Cleveland, Ohio.
Hemodialysis.com: What are the main findings of the study?
Dr. Schold: The primary findings demonstrated that donor quality has a significantly different effect depending on recipient characteristics. In particular, recipient race, age and diabetic status strongly modified the impact of donor quality.
