Delayed graft function

Background: Despite growing waiting lists for renal transplants, hesitations persist with regard to the use of deceased after cardiac death (DCD) renal grafts. We evaluated the outcomes of DCD donations in The Netherlands, the country with the highest proportion of DCD procedures (42.9%) to test whether these hesitations are justified. Methods: This study included all procedures with grafts donated after brain death (DBD) (n = 3611) and cardiac death (n = 2711) performed between 2000 and 2017. Transplant outcomes were compared by Kaplan Meier and Cox regression analysis, and factors associated with short (within 90 days of transplantation) and long-term graft loss evaluated in multi-variable analyses. Findings: Despite higher incidences of early graft loss (+50%) and delayed graft function (+250%) in DCD grafts, 10-year graft and recipient survival were similar for the two graft types (Combined 10-year graft survival: 73.9% (95% CI: 72.5-75.2), combined recipient survival: 64.5% (95 CI: 63.0-66.0%)). Long-term outcome equivalence was explained by a reduced impact of delayed graft function on DCD graft survival (RR: 0.69 (95% CI: 0.55-0.87), p b 0.001). Mid and long-term graft function (eGFR), and the impact of incident delayed graft function on eGFR were similar for DBD and DCD grafts. Interpretation: Mid and long term outcomes for DCD grafts are equivalent to DBD kidneys. Poorer short term outcomes are offset by a lesser impact of delayed graft function on DCD graft survival. This nation-wide evaluation does not justify the reluctance to use of DCD renal grafts. A strong focus on short-term outcome neglects the superior recovery potential of DCD grafts.

Delayed graft function (DGF) is a common complication after kidney transplantation in the era of accepting an equal number of brain- and circulatory-death donor kidneys in the Netherlands. To identify those cases with an increased risk of developing DGF, various multivariable algorithms have been proposed. The objective was to validate the reproducibility of four predictive algorithms by Irish et al. (A risk prediction model for delayed graft function in the current era of deceased donor renal transplantation. Am J Transplant 2010;10:2279-2286) (USA), Jeldres et al. (Prediction of delayed graft function after renal transplantation. Can Urol Assoc J 2009;3:377-382) (Canada), Chapal et al. (A useful scoring system for the prediction and management of delayed graft function following kidney transplantation from cadaveric donors. Kidney Int 2014;86:1130-1139) (France) and Zaza et al. (Predictive model for delayed graft function based on easily available pre-renal transplant variables. I...

Delayed graft function (DGF) has a negative effect on the results of living-donor kidney transplantation. To investigate potential risk factors for DGF. This prospective study included 200 consecutive living donors and their recipients between January 2002 and July 2007. Delayed graft function was defined as need for dialysis within the first postoperative week. Delayed graft function was diagnosed in 12 patients (6%). Intraoperative complications occurred in 10 donors (5%), and postoperative complications in 24 donors (13.5%). One-year kidney graft survival with vs without DGF was 52% and 98%, respectively (P < .002). In donors, 2 univariate risk factors for DGF identified were lower counts per second at peak activity during scintigraphy, and multiple renal veins. In recipients, only 2 or more kidney transplantations and occurrence of an acute rejection episode were important factors. At multivariate analysis, increased risk of DGF was associated with the presence of multiple re...

Acute tubular necrosis (ATN) remains one of the most frequent causes of delayed graft function (DGF) following renal transplantation, particularly in the early postoperative period. It is commonly associated with ischemia-reperfusion injury, prolonged cold or warm ischemia time, donor-related hemodynamic instability, and the nephrotoxic effects of calcineurin inhibitors (CNI) such as cyclosporine. ATN contributes significantly to early post-transplant morbidity, impacts long-term graft survival, and poses diagnostic challenges due to its clinical overlap with acute rejection. Cyclosporine-induced nephrotoxicity can result in severe tubular injury, leading to ATN, particularly in the early post-transplant period. Despite its efficacy in preventing graft rejection, cyclosporine's toxic effects on the renal vasculature and tubular cells can exacerbate ischemia-reperfusion injury, prolong graft dysfunction, and increase the need for dialysis. Here, we report a case of ATN following renal transplantation in a patient who was on cyclosporine.

What reduction in BMI SDS is required in obese adolescents to improve body composition and cardiometabolic health? Arch Dis Child 2010; 95: 256-261 24. Reinehr T, Andler W. Changes in the atherogenic risk factor profile according to degree of weight loss. Arch Dis Child 2004; 89: 419-422

Acute kidney injury (AKI) is common in hospitalised patients and is associated with high mortality rates. However, the epidemiology of AKI in urology patients may differ due to a higher proportion of post-renal causes and surgical procedures that result in the intentional removal of renal parenchyma. We performed a study to examine the incidence, aetiology and outcomes of AKI in a urological population. We performed a single-centre observational study including all hospitalised patients who sustained AKI within the Urology Department over an 18 month period. Patients with AKI were prospectively identified by a hospital-wide, electronic AKI reporting system that also allows demographic, hospital admission and co-morbidity data collection. Data regarding aetiology of AKI and details of surgical procedures were added retrospectively by manual case-note search. 587 episodes of AKI occurred in 410 urology patients, giving an overall incidence of 6.7%. 137 (33.4%) were elective cases of w...

Background: Reperfusion injury and the acid-base status of the transplant are important factors affecting post-transplantation graft function. Objective: We hypothesized that infusing hypertonic saline (HS) or tight control of acid-base status of the blood rushing through renal graft using sodium bicarbonate may have beneficial effects on early graft function. Methods: Candidates for deceased-donor kidney transplant were randomized into three groups. HS group (n=33) received 50 mL/kg normal saline (NS) titrated during operation plus 4 mL/kg of 5% HS just within graft reperfusion phase; bicarbonate group (n=37) was administered 60 mL/kg NS while their metabolic acidosis (base excess ≤5 mEq/L) was tightly corrected every 30 min with sodium bicarbonate; and a control group (n=36) that received 60 mL/kg normal saline while they were administered sodium bicarbonate only, if they encountered severe metabolic acidosis (base excess ≤15 mEq/L). The primary outcome was defined as early post-operative renal function evaluated based on serial serum creatinine levels. The study was registered in Iranian Registry of Clinical Trials (IRCT2013122815841N19). Results: Post-operative early graft function improved significantly during the first 3 days in the intervention groups (p<0.05). However, that beneficial effect no longer remained at the same level after the day four. Conclusion: Timely administration of HS or tight control of metabolic acidosis with sodium bicarbonate infusion improve early renal function during renal transplant surgery.

Heart transplantation is the definitive treatment for end-stage heart
failure, yet the persistent scarcity of donor organs has necessitated
expanded criteria for donor selection, particularly the inclusion of
donors after brain death (DBD) and circulatory death (DCD). These
two mechanisms of donor death result in distinct pathophysiological
alterations that impact myocardial viability, inflammatory activation,
and immune recognition. DBD is characterized by a catecholamine
surge, hormonal collapse, and systemic inflammation, contributing to
endothelial dysfunction and immunologic priming. In contrast, DCD
grafts are subjected to warm ischemia and reperfusion injury, elevating
the risk of primary graft dysfunction and delayed recovery. These
physiological differences may differentially influence graft performance,
immunologic rejection, infection risk, and long-term survival. This review
presents a detailed analysis of how the cause of donor death influences
clinical outcomes in heart transplantation. It explores the mechanistic
underpinnings of DBD- and DCD-associated injury, assesses their impact
on post-transplant complications, and evaluates emerging strategies such
as ex vivo perfusion, donor-derived cell-free DNA monitoring, and gene
expression profiling. Additionally, it discusses how donor physiology
intersects with recipient characteristics, the selective use of heterotopic
transplantation, and evolving approaches in immunosuppression and risk
stratification. These insights support the development of precision-guided
protocols that integrate donor and recipient profiles to optimize graft
utilization and improve outcomes.

Terminally ill patients who do not meet brain death criteria and die of cardiac arrest after withdrawal of life support may be considered as potential organ donors: such donors are referred to as controlled donors after cardiac death (DCD). Controlled DCD donors are increasingly being used in Northern Europe and the United States in an effort to expand the donor pool. Ethical concerns regarding the diagnosis of death based on cardiopulmonary rather than neurological criteria have largely been resolved over the past decade. Follow-up studies of recipients by several transplant centers have shown that functioning controlled DCD kidneys are equivalent to kidneys from conventional brain-dead donors with respect to long-term prognosis. Concerns about long-term repercussions for the higher incidence of delayed graft function with DCD kidneys are not supported by the current evidence. The donor pool may be further expanded by transplanting selected kidneys from older DCD, in particular for the increasing population of older kidney transplant candidates. Successful transplantation of these delicate organs is possible when donors and recipients are carefully managed by well-trained, motivated, and effectively collaborating transplant personnel.

Development of delayed graft function (DGF) following kidney transplant is associated with poor outcomes. An ability to rapidly identify patients with DGF versus those with immediate graft function (IGF) may facilitate the treatment of DGF and the research needed to improve prognosis. The purpose of this study was to use a Targeted Urine Proteome Assay (TUPA) to identify protein biomarkers of delayed recovery from kidney transplant. Potential biomarkers were identified using the TUPA Multiple Reaction Monitoring (MRM) assay to interrogate the relative DGF/IGF levels of expression of 167 proteins in urine taken 12-18 hours after kidney implantation from 21 DGF, 15 SGF (slow graft function), and 16 IGF patients. An iterative Random Forest analysis approach evaluated the relative importance of each biomarker, which was then used to identify an optimum biomarker panel that provided the maximum sensitivity and specificity with the least number of biomarkers. Four proteins were identified...

Cadaveric donors can provide an effective solution to the problem of organ shortage, and many factors that may affect the functioning and survival of cadaveric kidneys have been studied. We aimed to clarify the impact of donor age and acute rejection episodes on long-term graft and patient survival in patients receiving cadaveric renal transplants. We retrospectively evaluated the long-term outcomes of 207 patients who had received cadaveric renal transplants between 1985 and 2004. Mean recipient age, HLA mismatch, mean donor age, delayed graft function (DGF), mean cold ischemia time, acute rejection episodes in the first 6 months after transplantation, and 1-, 3-, and 5-year graft survivals were evaluated. Two study groups were created according to donor age: group 1 (n ϭ 126) was composed of patients receiving kidneys from donors younger than 50 years, and group 2 (n ϭ 81) was composed of patients receiving kidneys from donors 50 years of age or older. Mean recipient age, HLA mismatch, and mean cold ischemia time between groups were not different. The DGF rate in group 1 was 40% (n ϭ 50) and in group 2 was 46% (n ϭ 37) (P Ͼ .05). The 1-, 3-, and 5-year survival rates of patients without acute rejection within the first 6 months after transplantation in group 1 (58/126; 46%) versus those in group 2 (46/81; 57%) were 95% versus 90%, 65% versus 60%, and 40% versus 35%, respectively (P Ͼ .05). The 1-, 3-, and 5-year graft survival rates of patients with acute rejection within the first 6 months in group 1 (n ϭ 68) versus those in group 2 (n ϭ 35) were 93% versus 89%, 71% versus 55%, and 44% versus 28%, respectively (P ϭ .005). There was no significant difference in 1-, 3-, and 5-year survival rates between patients with DGF in both groups. Acute rejection episodes within the first 6 months after cadaveric transplantation, especially in patients receiving kidneys from donors older than 50 years, were shown to affect 5-year survival of the kidney graft. However, cadaver age alone had no negative effect on 5-year graft survival rates. Cadaveric donors older than 50 years may be a solution to the organ shortage in the treatment of end-stage renal disease.

Delayed graft function (DGF) compromises long-term renal allograft function. The infl uence of the time taken to complete the vascular anastomoses (anastomosis time) on DGF has only sparsely been demonstrated and its infl uence on long-term graft function is even less characterized. M: From 614 kidney transplantations from brain death donors cold ischemia (start of in situ cold perfusion to start of anastomoses) and anastomosis times (kidney out of ice to reperfusion) were prospectively recorded. The occurrence of DGF and graft function (eGFR) at 3 and 12 months after transplantation were analyzed using multivariate logistic and linear regression methods. Covariates included were anastomosis time, cold ischemia time, HLA mismatch, donor and recipient age. DGF and recipient body mass index (BMI) were added to the model when specifi ed. R: Anastomosis time was an independent risk factor for DGF (OR = 1.058, 95% CI 1.032-1.084). The risk of DGF increased with 63% for every 10 min of anastomosis time. Graft function decreased at 3 and 12 months after transplantation with every 10 min increase in anastomosis time (p < 0.001 and p = 0.024, respectively). Adjusted for cold ischemia time, HLA mismatch, donor and recipient age, anastomosis time was independently associated with worse graft function at 3 and 12 months after transplantation (p = 0.005 and p = 0.038, respectively). Even independently from DGF, anastomosis time remained a risk factor for worse graft function at 3 months (p = 0.019), but not at 12 months. Longer anastomosis time was associated with higher BMI (p = 0.002, correlation coeffi cient 0.145). Adjusted for BMI, anastomosis time remained an independent risk factor for DGF (OR 1.094, 95% CI 1.037-1.107) and for worse graft function at 3 and 12 months (both p = 0.005). C: In kidney transplants from brain death donors, anastomosis time independently increased the risk of DGF and worsened allograft function up to one year after transplantation. All efforts should be made to reduce the anastomosis time.

The aim of the study was to compare the effects of renal ice slush hypothermia and the use of trimetazidine in the protection against ischemia/reperfusion (I/R) injury. Materials and Methods: Fifteen farm pigs were submitted to left kidney ischemia and right nephrectomy during the same procedure. Animals were divided into three groups. Group 1 was submitted to warm ischemia; Group 2 was submitted to cold ischemia with ice slush; and Group 3 received trimetazidine 20 mg one day and 4 hours before surgery. Ischemia time was 120 minutes in all three groups. Serum creatinine (SCr) and plasma iohexol clearance (CLioh) were measured before surgery and on postoperative days (PODs) 1,3,7, and 14. Semi-quantitative analyses of histological alterations were performed by a pathologist. A p value of < 0.05 was considered significant. Results: All groups showed elevation of serum creatinine in the first week. Serum creatinine was higher in Group 3 in the first and third postoperative days (Mean Cr: 5.5 and 8.1 respectively). Group 2 showed a lower increase in creatinine and a lower decrease in iohexol clearance than the others. Renal function stabilized in the fourteenth POD in all three groups. Analyses of histological alterations did not reach statistical significance between groups. Conclusion: Trimetazidine did not show protection against renal I/R injury in comparison to warm ischemia or hypothermia in a porcine model submitted to 120 minutes of renal ischemia.

Introduction Delayed graft function (DGF) is considered a risk factor for rejection after kidney transplantation (KTx). Clinical guidelines recommend weekly allograft biopsy until DGF resolves. However, who may benefit the most from such an aggressive policy and when histology should be evaluated remain debated. Methods We analyzed 223 biopsies in 145 deceased donor KTx treated with basiliximab or anti-thymocyte globulin (rATG) and calcineurin inhibitor-based maintenance. The aim of the study was to assess the utility and safety of biopsies performed within 28 days of transplant. Relationships between transplant characteristics, indication, timing, and biopsy-related outcomes were evaluated. Results Main indication for biopsy was DGF (87.8%) followed by lack of improvement in graft function (9.2%), and worsening graft function (3.1%). Acute tubular necrosis was the leading diagnosis (89.8%) whereas rejection was detected in 8.2% specimens. Rejection was more frequent in patients biopsied due to worsening graft function or lack of improvement in graft function than DGF (66.7% vs. 3.5%; P = 0.0075 and 33.3% vs. 3.5%; P = 0.0104, respectively) and in biopsies performed between day 15 and 28 than from day 0 to 14 (31.2% vs. 3.7%; P = 0.0002). Complication rate was 4.1%. Management was affected by the information gained with histology in 12.2% cases (7% considering DGF). Conclusions In low-immunological risk recipients treated with induction and calcineurin inhibitors maintenance, protocol biopsies obtained within 2 weeks of surgery to rule out rejection during DGF do not necessarily offer a favourable balance between risks and benefits. In these patients, a tailored approach may minimize complications thus optimizing results.

Autosomal-dominant polycystic kidney disease as a risk factor for diabetes mellitus following renal transplantation. Background.Posttransplant diabetes mellitus is an important complication of renal transplantation that is associated with a significant impact on quality of life and an increase in long-term morbidity and mortality. Autosomal-dominant polycystic kidney disease (ADPKD) is a hereditary disease that commonly leads to end-stage renal disease (ESRD) in adulthood. The association between ADPKD and posttransplant diabetes mellitus has not been previously studied in a large cohort of patients. Methods. To address this question, we studied a cohort of 135 patients with ADPKD who received a first renal-only transplant between January 1985 and December 1999. An age, race, and date of transplant-matched cohort of 135 non-ADPKD subjects were used as the control population. Results. The cohorts were similar at baseline for gender distribution, body mass index (BMI), proportion of obese subjects (BMI greater than 30 kg/m 2 ), family history of diabetes mellitus, and type of donor (deceased or living). At 12 months, the incidence of posttransplant diabetes mellitus was significantly higher in patients with ADPKD when compared to the controls (17% vs. 7.4%) (P = 0.016), despite no significant differences in the BMI, percent increase in BMI, number of acute rejections, prednisone dose at 3 and 6 months, use of diuretics or beta blockers, delayed graft function, or serum creatinine levels. The proportion of subjects requiring insulin was significantly higher in the ADPKD group (11.1% vs. 3%) (P = 0.009). Variables significantly associated with posttransplant diabetes mellitus at 1 year by bivariate analyses were the diagnosis of ADPKD (P = 0.02), BMI at transplant (P = 0.04), obesity at 12 months (P = 0.01), and delayed graft function (P = 0.02). Gender of recipient (P = 0.9), family history of diabetes (P = 0.3), prednisone dose at 3 months (P = 0.9) and 6 months (P = 0.7), acute rejection (P = 0.9), use of beta blockers or tacrolimus (P = 0.8), deceased donor transplant (P = 0.2), and serum creatinine at 1 year (P = 0.5) were not associated with posttransplant diabetes mellitus. A trend toward increased incidence of posttransplant diabetes mellitus was found with the use of diuretics post transplant (P = 0.054).

Background Ischaemia–reperfusion (I/R) damage is a relevant cause of delayed graft function (DGF). Complement activation is involved in experimental I/R injury, but few data are available from kidney transplant (KT) patients. We studied the dynamics of membrane attack complex (C5b-9) as a soluble fraction (SC5b-9) and the histological deposit pattern of C3b, complement Factor H (FH) and C5b-9 in DGF patients. Methods We evaluated SC5b-9 levels in 59 recipients: 38 with immediate graft function and 21 with DGF. The SC5b-9 was measured at admission for KT and 7 days after KT. DGF-kidney biopsies (n = 12) and a control group of 1-year protocol biopsies without tissue damage (n = 4) were stained for C5b-9, C3b and FH. Results SC5b-9 increased significantly in DGF patients (Day 0: 6621 ± 2202 mAU/L versus Day 7: 9626 ± 4142  mAU/L; P = 0.006), while it remained stable in non-DGF patients. Days 0–7 increase &gt;5% was the better cut-off associated with DGF versus non-DGF patient discrimin...

The role of C5a receptors (C5aR1 and C5L2) in renal ischemia-reperfusion injury (IRI) is uncertain. We generated an in vitro model of hypoxia/reoxygenation with human proximal tubule epithelial cells to mimic some IRI events. C5aR1, membrane attack complex (MAC) and factor H (FH) deposits were evaluated with immunofluorescence. Quantitative polymerase chain reaction evaluated the expression of C5aR1, C5L2 genes as well as genes related to tubular injury, inflammation, and profibrotic pathways. Additionally, C5aR1 and C5L2 deposits were evaluated in kidney graft biopsies (KB) from transplant patients with delayed graft function (DGF, n = 12) and compared with a control group (n = 8). We observed higher immunofluorescence expression of C5aR1, MAC and FH as higher expression of genes related to tubular injury, inflammatory and profibrotic pathways and of C5aR1 in the hypoxic cells; whereas, C5L2 gene expression was unaffected by the hypoxic stimulus. Regarding KB, C5aR1 was detected in...

Delayed Graft Function (DGF) is a common complication of renal transplants and the long-term relation between DGF and survival of patients and grafts is not well established. This is a historical cohort study of transplanted patients in Taleghani Hospital of Shahid Beheshti University in Iran between 1994 and 2010. Patients who required dialysis during the first week after transplantation were considered to have DGF. The patients&#39; conditions were updated to determine existing graft function, graft loss or patients&#39; death at one year and five years post transplantation in relation to the presence or absence of DGF. DGF complicated 67/385 transplants (17.4%). Causes included acute tubular necrosis (58.2%), accelerated rejection (29.9%), transplant renal artery thrombosis (9%) and renal vein thrombosis (3%). More kidneys in the DGF group were procured from cadaveric donors (6% versus 0.9%, P = 0.02). At hospital discharge, patients with DGF had significantly higher mean creatin...

Subclinical rejection (SCR) has been variably associated with reduced graft survival, development and progression of interstitial fibrosis/tubular atrophy and chronic allograft nephropathy, but data are controversial concerning SCR treatment in terms of graft survival improvement. In this single-center retrospective study, we enrolled 174 adult kidney transplant recipients with a protocol biopsy performed at 30 days after transplantation to evaluate the incidence rate and risk factors for early SCR and its impact on 10-year graft survival. Five patients showed primary non function and were excluded. Among 159/169 (94.08 %) patients with stable graft function who underwent protocol biopsy, 17 (10.7 %) showed signs of SCR and were treated with low-dose intravenous (i.v.) steroids. Ten patients showed functional impairment, 8 (4.73 %) resulting as acute rejection. At multivariate analysis, donor age [odds ratio (OR) 1.04, 95 % confidence interval (CI) 1.01-1.09], and delayed graft function (DGF) (OR 1.08, 95 % CI 1.03-1.12) were significantly associated with SCR. The 10-year graft survival rate in the SCR group was similar to that in the normal-findings group (76.5 vs. 74.9 % respectively; p = 0.61). At multivariate Cox regression, acute [hazard ratio (HR) 5.22, 95 % CI 1.70-16.01], but not sub-clinical, rejection was independently associated with long-term graft failure. In conclusion, early protocol biopsy is a useful and safe tool to detect early SCR which seems not to affect the long-term survival. We suggest that this could be, probably, linked to early SCR treatment with low dose i.v. steroids.

Background: Ischemia reperfusion injury (IRI) is one of the risk factors for delayed graft function, acute rejection and long term allograft survival after kidney transplantation. IRI is an independent antigen inflammatory process that produces tissue damage. Our objective was to study the impact of immunosuppressive treatment (IS) on IRI applying only one dose of IS before orthotopic kidney autotransplantation. Methods: Twenty-four rats allocated in four groups were studied. One group served as control (G1: autotransplanted rats without IS) and the rest received IS 12 h before kidney autotransplantation (G2: Rapamycin, G3: Mycophenolate mofetil and G4: Tacrolimus). Results: Improved renal function and systemic inflammatory response were found among IS groups compared to the control group (Delta Urea p b 0.0001; Delta Creatinine p b 0.0001; Delta C3 pb 0.001). The number of apoptotic nuclei in renal medulla in G1 was higher than in IS groups (p b 0.0001). Tubular damage was less severe in IS groups respecting G1 (p b 0.001). C3, TNF-α and IL-6 expression in kidney samples was reduced when IS was used compared to the control group. No differences were observed among the different immunosuppressive drugs tested. However, Heme oxygenase-1(HO-1) was increased only in Rapamycin treatment. Conclusions: These data suggest that the use of IS administered before transplant attenuates the IRI process after kidney transplantation in an animal model.

Interest in machine perfusion (MP) for donated kidneys has markedly increased in the past decade as a means to improve graft function, although the donor populations in which it should be applied have not yet been resolved. All adults undergoing de-novo isolated kidney transplantation from standard-criteria donors in the UNOS database 2005 to 2011 were reviewed with the primary endpoint of delayed graft function (DGF), defined as dialysis within seven days of transplantation, in those who received kidneys that underwent MP versus cold storage (CS) alone. Three methods were used to control for differences between groups. Multivariable logistic regression was performed, adjusting for donor and recipient characteristics significantly associated with DGF. Rates were also compared in a cohort of propensity-matched MP vs CS recipients. Finally, a paired-kidney study was performed, where one kidney underwent MP and the contralateral underwent CS. There were 36,323 patients, with unadjusted...

Background: Pre-emptive kidney transplantation improves patient
outcomes by avoiding dialysis-related complications; however, it carries
a risk of delayed graft function (DGF) and acute rejection, particularly
in high-risk recipients. Anti-thymocyte globulin (ATG), frequently used
for immunosuppression, may induce cytokine release syndrome (CRS), a
severe inflammatory condition associated with multi-organ dysfunction.
Case Presentation: We report the case of a 23-year-old male with IgA
nephropathy who developed severe CRS with multi-organ involvement
following recurrent ATG administration after kidney transplantation.
The patient presented with acute kidney injury, acute respiratory distress
syndrome (ARDS), and hemodynamic instability requiring vasopressors
and intensive care support. Continuous renal replacement therapy (CRRT)
was initiated, and a CytoSorb® hemoadsorption cartridge was integrated
into the circuit to modulate the cytokine response. Three consecutive 24-
hour hemoadsorption sessions resulted in rapid clinical improvement,
including hemodynamic stabilization, restoration of renal function, and
respiratory recovery.
Conclusion: This case illustrates the potential role of cytokine adsorption
as an adjunctive strategy for managing severe CRS in the post-transplant
setting. CytoSorb hemoadsorption contributed to the reversal of multiorgan dysfunction, supporting its application in the treatment of
hyperinflammatory complications following immunosuppressive therapy.
Further studies are warranted to validate its efficacy and define optimal
clinical use

Dr. sc. Julijan Dobriniae, red. profesor Cvjetni put 4 51410 Opatija DR. KARL STOCKERT, MORNARIÈKI ÈASNIK I NUMIZMATIÈAR* Uvod Pitanje upotpunjavanja hrvatske numizmatièke bibliografije i biobibliografije postoji dugi niz godina, iako vlada miljenje kako bi tu problematiku trebalo barem sistematizirati u dogledno vrijeme. S radovima numizmatièkog sadraja javljaju se, u naim i inim starim i recentnim èasopisima, mnogi autori, manje ili vie znaèajni za hrvatsku numizmatiku. Djelokrug njihovog djelovanja, kao i njihovih pisanih radova obuhvaaea podruèja od antièke do moderne numizmatike. Svakako da je za nae nacionalno biaee najznaèajnije srednjovjekovno razdoblje. Stoga se i numizmatièare, koji su se bavili tom tematikom, smatra neto znaèajnijima. No, nizom povijesnih razloga, za neke od njih koji su, obradivi bitne dijelove srednjovjekovne numizmatike, ipak ostali irokom krugu numizmatièara manje poznati, moglo bi se reaei da su neopravdano zapostavljeni. U plejadi sabiraèa i utemeljitelja numizmatièkih zbirki svakako treba spomenuti barem neke od istaknutih najstarijih, kao

Dr. sc. Julijan Dobriniae, red. profesor Cvjetni put 4 51410 Opatija DR. KARL STOCKERT, MORNARIÈKI ÈASNIK I NUMIZMATIÈAR* Uvod Pitanje upotpunjavanja hrvatske numizmatièke bibliografije i biobibliografije postoji dugi niz godina, iako vlada miljenje kako bi tu problematiku trebalo barem sistematizirati u dogledno vrijeme. S radovima numizmatièkog sadraja javljaju se, u naim i inim starim i recentnim èasopisima, mnogi autori, manje ili vie znaèajni za hrvatsku numizmatiku. Djelokrug njihovog djelovanja, kao i njihovih pisanih radova obuhvaaea podruèja od antièke do moderne numizmatike. Svakako da je za nae nacionalno biaee najznaèajnije srednjovjekovno razdoblje. Stoga se i numizmatièare, koji su se bavili tom tematikom, smatra neto znaèajnijima. No, nizom povijesnih razloga, za neke od njih koji su, obradivi bitne dijelove srednjovjekovne numizmatike, ipak ostali irokom krugu numizmatièara manje poznati, moglo bi se reaei da su neopravdano zapostavljeni. U plejadi sabiraèa i utemeljitelja numizmatièkih zbirki svakako treba spomenuti barem neke od istaknutih najstarijih, kao

Delayed graft function (DGF) in kidney transplantation affects adverse outcomes. It remains unclear whether the post-transplant dialysis modality alters perioperative or long-term graft outcomes. We performed a retrospective observational quality initiative at two Canadian renal transplant centers, in which DGF occurred in the recipient, necessitating one of peritoneal dialysis (PD) or hemodialysis (HD). There was no difference in baseline factors between patients with post-transplant PD (n = 14) or HD (n = 63). The use of PD was associated with an increased risk of wound infection/leakage (PD 5/14 vs. HD 6/63, p = 0.024), shorter length of hospitalization (13.7 vs. 18.7 d, p = 0.009) and time requiring dialysis post-operatively (6.5 vs 11.0 d, p = 0.043). There were no differences in readmission to hospital within 6 months (4/14 vs. 23/63, p = 0.759), graft loss (0/14 vs. 2/63, p = 1.000) or acute rejection episodes (1/14 vs. 4/63, p = 1.000) at one yr, and GFR did not differ between the PD or HD groups at 30 d (35.7 vs. 33.8 mL/min/m 2 , p = 0.731), six months (46.9 vs. 45.5 mL/min/m 2 , p = 0.835) or one yr (46.6 vs. 44.5 mL/min/m 2 , p = 0.746). Further research is needed to determine which transplant patients are most appropriate to undergo PD catheter removal at the time of transplantation.

NO. As renal DNA oxidative injury paralleled NO, increasing Promising effects of ischemic preconditioning in renal transplantation. with prolongation of reperfusion, it may account for the disap-Background. Ischemic preconditioning, a phenomenon inpearance of preconditioning. Finally, the one-cycle precondiduced by brief ischemia and reperfusion periods, renders an tioning schedule offered an effective functional and histological organ tolerant to subsequent prolonged ischemia. This study protection against cold preservation damage in rat renal transevaluated different schedules of preconditioning the kidney to plantation. assess the role of nitric oxide (NO) and determine the effects Conclusions. Fifteen minutes of warm ischemia and 10 minof preconditioning on kidney transplantation. utes of reperfusion in the kidney is the most suitable one-cycle Methods. In study design A, to determine the optimum proschedule for preconditioning since it protects from both warm cedure of preconditioning, one-cycle schedules were assayed by and cold ischemia. The beneficial effect of preconditioning is occluding/releasing renal pedicles according to various warm related to the local production of NO, and we believe it has ischemic (5, 10, 15, 20 min) and reperfusion (10, 20, 40 min) promising therapeutic value in clinical renal transplantation. windows in Sprague-Dawley rats. Thereafter, warm renal ischemia was induced by clamping both pedicles for 40 minutes. Design B used the most suitable schedule found from the first In renal transplantation, the deleterious effect of destudy to obtain several groups, using either a direct nitric oxide layed graft function secondary to ischemia-reperfusion donor (spermine NONOate) or two nitric oxide synthase (NOS) blockers (L-NAME and aminoguanidine), to determine damage may act to trigger or amplify host allo-response whether NO mediates in renal preconditioning. To establish and influence both the acute rejection occurrence [1] whether preconditioning reduces cold preservation damage, in and late chronic changes [2]. Thus, protective maneuvers Design C the optimum preconditioning schedule was used in at the time of transplantation should clearly benefit the syngeneic Lewis rats where preconditioned and non-precondifate of the organ. tioned kidneys were transplanted after five hours of cold stor-Ischemic preconditioning, a phenomenon induced by age in Euro-Collins solution. Results. The best preconditioning schedule consisted of 15 brief ischemia and reperfusion periods, renders an organ minutes of warm ischemia and 10 minutes of reperfusion (Prec more tolerant to subsequent sustained ischemia-reper-15/10), since it was the only schedule that offered both funcfusion [3]. This phenomenon has been mainly studied tional and histological protection. The NO donor reproduced and characterized in the heart [3, 4], but it has also been the ischemic preconditioning. Non-selective NOS blockade described in the liver [4-6], the small intestine [7, 8] and abolished the preconditioning and exacerbated ischemic damthe brain [9]; however, little information available in the age, which was overcome by the addition of the NO donor. kidney. A report in the early 1980s focused on the late Selective blocking of inducible NOS also abolished the effects of preconditioning. Renal NO increased at the end of precondiacquisition of resistance against ischemic injury through tioning in the Prec 15/10 group. Prolongation of the reperfusion the induction of intrinsic antioxidant enzymes by a previwindow (20 or 40 min) abolished the preconditioning protecous episode of short ischemia [10]. This is a proteintion, although it was associated with a further increase in renal dependent mechanism similar to the late phase of preconditioning described in the heart [11]. More recently, some studies concerning early protection of renal tissue

Rate of acceptance of deceased-donor kidneys decreases with donor age despite the growing number of aged transplant candidates on the waiting list. In the Eurotransplant Senior Program, HLA-unmatched kidneys from deceased donors aged Ն65 yr are transplanted regionally into recipients aged Ն65 yr. Because we have become more willing to accept kidneys from donors aged Ն75 yr than previous years, we performed a retrospective analysis of this subgroup. Kidneys were accepted from donors aged Ն75 yr provided a normal creatinine on admission to the hospital, a Cockcroft-Gault creatinine clearance Ͼ80 ml/min, and an absence of comorbidities. We compared outcomes of kidneys from donors aged Ն75 yr with both younger-donor kidneys transplanted in the Eurotransplant Senior Program and with younger-donor HLA-matched kidneys transplanted into recipients Ն60 yr. There were no differences in 5-yr graft and patient survival or rate of delayed graft function between groups. Graft function, measured by creatinine and creatinine clearance, differed without pattern at only three of 12 time points during 5 yr of follow-up. In conclusion, our data suggest that kidneys from deceased donors aged Ն75 yr can be transplanted safely into recipients aged Ն65 yr if similar donor criteria and local allocation practices are used.

Background. Prolonged cold ischemia time (CIT) is accompanied by delayed cadaveric renal allograft function and early allograft loss, but the effect of CIT on long-term allograft survival is less certain and has not been studied in detail. Methods. Using data from the United Network for Organ Sharing, we identified 6465 patients who received a kidney-only transplant of cadaveric origin for the first time in 1995. We examined the effect of CIT on the 6-year survival of these kidneys using Cox proportional hazard analysis. Results. The mean CIT of the kidney was 21 ± 7 hours (mean ± SD) and correlated with the serum creatinine on discharge (R = 0.20, P < 0.001) and the distance traveled by the kidneys (R = 0.30, P < 0.001). CIT had a significant effect on the 6-year allograft survival (a 10-hour increase in CIT was associated with a hazard risk ratio (RR) of 1.20 for graft failure (P < 0.001) that persisted (RR = 1.40, P = 0.021) after adjusting for donor age, recipient age and race, human leukocyte antigen (HLA) mismatch, panel reactive antibodies, and first 6 months' rejection treatments. Similarly, compared to CIT category of 0 to 10 hours, the 6-year graft survival was progressively worse for 11 to 20 hours (RR = 1.03), 21 to 30 hours (RR = 1.12), and, significantly so, for >30 hours (RR = 1.32; P = 0.011). The gain in HLA match with increasing CIT was not uniform; for instance, HLA match in >30 hours was lower than for 21 to 30 hours (2.4 ± 1.5 vs. 2.7 ± 1.6; P < 0.001). (1) Cadaveric kidneys continue to undergo prolonged periods of cold ischemia; (2) prolonged cold storage is associated with longer distance traveled by the kidneys, but is not associated with any significant gain in tissue matching; and (3) prolonged cold ischemia is a significant predictor of longterm graft loss. Reducing prolonged cold ischemia by regional distribution of organs and less stringent tissue matching may reduce the persistent high rate of long-term loss of cadaveric renal allografts.

Nephrocalcinosis, characterized by intratubular and/or parenchymal deposition of calcium phosphate and calcium oxalate crystals, is frequently seen in renal allograft biopsies; however, the clinical consequence of this histologic finding remains unknown. Kidney transplant recipients with good allograft function usually demonstrate improvement in biochemical parameters; however, persistent hyperparathyroidism remains prevalent in this population of patients. We identified renal allografts with nephrocalcinosis and evaluated the effects on renal allograft function and survival. We conducted a single-center, retrospective review of kidney allograft biopsies performed at our center from December 1, 2006 to November 30, 2012. Biopsies with nephrocalcinosis as the primary diagnosis were included in the final analysis. Biochemical parameters at the time of biopsy included serum creatinine, phosphate, calcium, intact parathyroid hormone (iPTH), 25-hydroxy vitamin D, and albumin. Serum creat...

Background. The purpose of this study was to evaluate long-term outcomes in high risk renal transplant recipients over 60 years of age compared with those younger than 60 years of age. Materials and Methods. We analyzed outcomes in 131 consecutive renal transplant recipients at our institution between November 2001 and December 2007. Primary outcomes included incidence of delayed graft function (DGF), acute rejection, graft survival, patient survival, and incidence of infections and neoplasms. Results. Older recipients (Over 60 group, n [ 45) received more organs from extended criteria donors (ECD) or donation after cardiac death donors (DCD) compared with younger recipients (Under 60 group, n [ 86), 42% versus 17% respectively, P [ 0.001. Multivariate analyses revealed that African American ethnicity and DCD donation had the greatest impact on the incidence of DGF in both groups; P < 0.05. Patient survival and graft survival beyond 1 y were similar between the two groups. Conclusion. Our data suggest that long-term transplant outcomes in older, high risk renal transplant recipients are similar to those of younger, high risk recipients. Older recipients' age and high-risk characteristics, such as African American ethnicity and increased sensitization, should not be a contraindication to renal transplantation in the elderly.

Cilj -Najveaei problem u daljem razvoju transplantacije bubrega je nedovoljan broj umrlih davatelja. Retrospektivno smo obradili grupu bolesnika koji su primili bubreg od umrle osobe uz primjenu perfuzije in situ. Materijal i metode -U razdoblju od 1989. do 2002. izvršili smo 21 transplantaciju bubrega uzetih od 11 davatelja nakon zastoja srca uz primjenu perfuzije in situ. Topla ishemija kretala se uz primjenu kardiopulmonalne reanimacije od 12 do 85 min. (srednja 50 ± 24 min.). Hladna ishemija trajala je od 7 h 30 min. do 26 h (srednja 19,42 ± 3,88 h). Rezultati -Sedam je bolesnika imalo ranu funkciju bubrega, a 11 odgoðenu. Primarna afunkcija transplantata nije zabilježena. Rasprava -Primjenom perfuzije in situ izbjegnuta je primarna afunkcija transplantata. To u našim uvjetima pruža osnovu za masovniju transplantaciju bubrega od davatelja s nekucajuaeim srcem.

Cilj -Najveaei problem u daljem razvoju transplantacije bubrega je nedovoljan broj umrlih davatelja. Retrospektivno smo obradili grupu bolesnika koji su primili bubreg od umrle osobe uz primjenu perfuzije in situ. Materijal i metode -U razdoblju od 1989. do 2002. izvršili smo 21 transplantaciju bubrega uzetih od 11 davatelja nakon zastoja srca uz primjenu perfuzije in situ. Topla ishemija kretala se uz primjenu kardiopulmonalne reanimacije od 12 do 85 min. (srednja 50 ± 24 min.). Hladna ishemija trajala je od 7 h 30 min. do 26 h (srednja 19,42 ± 3,88 h). Rezultati -Sedam je bolesnika imalo ranu funkciju bubrega, a 11 odgoðenu. Primarna afunkcija transplantata nije zabilježena. Rasprava -Primjenom perfuzije in situ izbjegnuta je primarna afunkcija transplantata. To u našim uvjetima pruža osnovu za masovniju transplantaciju bubrega od davatelja s nekucajuaeim srcem.

One of the key issues in contemporary transplantology is an objective assessment of a kidney donor to be performed before accepting the organ for transplantation. There have been various attempts at creating a numerical scale, based on donor, recipient, histological or machine perfusion parameters, to evaluate the quality of kidneys harvested from cadaver donors. Some of these were based on large populations of donor-recipient pairs and have been accepted by local organ allocation systems. As of yet none has been endorsed by international institutions a universal predictive model of graft function nor provided a uniform platform to initiate and to compare clinical studies. Originally proposed by Rao et al in 2009, the Kidney Donor Risk Index (KDRI) is a prediction model that assigns a continuous risk score to deceased donor kidneys, based on a donor and a transplant characteristics collected by the Organ Procurement and Transplantation Network (OPTN). The new kidney allocation system implemented in the US rates the harvested organs, based on KDRI. So far, few publications covered an assessment of the importance of risk KDRI for population recipients in other countries and it is also not known whether it is also an adequate prognostic tool for polish population of recipients.

One of the key issues in contemporary transplantology is an objective assessment of a kidney donor to be performed before accepting the organ for transplantation. There have been various attempts at creating a numerical scale, based on donor, recipient, histological or machine perfusion parameters, to evaluate the quality of kidneys harvested from cadaver donors. Some of these were based on large populations of donor-recipient pairs and have been accepted by local organ allocation systems. As of yet none has been endorsed by international institutions a universal predictive model of graft function nor provided a uniform platform to initiate and to compare clinical studies. Originally proposed by Rao et al in 2009, the Kidney Donor Risk Index (KDRI) is a prediction model that assigns a continuous risk score to deceased donor kidneys, based on a donor and a transplant characteristics collected by the Organ Procurement and Transplantation Network (OPTN). The new kidney allocation system implemented in the US rates the harvested organs, based on KDRI. So far, few publications covered an assessment of the importance of risk KDRI for population recipients in other countries and it is also not known whether it is also an adequate prognostic tool for polish population of recipients.

Background: Alcohol consumption is a potential risk factor with acute and chronic health consequences and social impacts, which is more prominent among men. There is no precise statistics on the scope of alcohol consumption in Iran; however, there is some evidences showing an increasing trend, particularly among young generation. In order to evaluate the scope of this issue in Kerman, a large city in the south-east of Iran, this exploratory study was designed to approach a group of people having an experience of alcohol use in 2014. Methods: Samples were recruited to the study using a snowball sampling. 200 eligible subjects were questioned about the type of alcohol consumed, frequency of use, and other factors associated with alcohol consumption. In order to maximize the validity of responses, data were collected through self-administered questionnaires. Findings: The main alcoholic drinks consumed by individuals were the homemade distillates (46%), wine (22%), beer (14%), distilled spirits (11%), and medical alcohol (7%), respectively. The majority of individuals participating in the study (73%) used mostly homemade drinks; moreover, 63%, 26%, 9%, and 2% of subjects took monthly or less, two to four times a month, two to three times a week, and at least four times a week, respectively. Only 2% of the subjects were heavy consumers of alcoholic beverages. Conclusion: Due to the lack of control over homemade alcoholic beverages, its high levels can be a huge potential risk. Furthermore, it seems that both factors of access and price to be very effective in the amount of alcoholics taken by individuals. Therefore, further studies in this area will help to reduce the harm caused by alcohol consumption.

In a developing country such as India, cadaveric renal transplantation accounts for only less than 1% of total renal transplantations. The reasons for such a low rate of cadaveric transplantation are many, ranging from lack of awareness to socioeconomic reasons. Our institute conducted a statewide public awareness program and initiated an intercity organ harvesting program. This doubled the cadaveric renal transplantations in the last 2 years. We performed 38 cadaveric transplantations among 190 renal transplantations in the last year (August 2005 to July 2006). We retrieved kidneys from 21 donors, of whom 9 were outside our city. From 21 donors we transplanted 38 recipients; out of whom 3 received dual kidneys and one kidney was discarded. The Mean age of the donors was 41.4 Ϯ 18.2 years with a mean cold ischemia time of 6.9 Ϯ 3.8 hours. Sixty-eight percent had delayed graft function. At the last follow-up, which was 190 Ϯ 98 days, patient survival rate was 90%: 4 patients died, including 2 due to bacterial sepsis and 2 due to cytomegalovirus (CMV) disease. The Graft survival rate was 85%, and the death-censored graft survival rate was 90%. Mean serum creatinine value at the last follow-up was 1.2 Ϯ 0.3 mg%. There were 5 episodes of acute rejection in 31 patients during first 3 months (16% acute rejection rate). The increase in cadaveric transplantations was associated with satisfactory patient and graft survival despite the high incidence of delayed graft function. From the Department of Nephrology and Transplantation Medicine (A.F.

Worldwide shortage of standard brain dead donors (DBD) has revived the use of kidneys donated after circulatory death (DCD). We reviewed the Belgian DCD kidney transplant (KT) experience since its reintroduction in 2000. Risk factors for delayed graft function (DGF) were identified using multivariate analysis. Five-year patient/graft survival was assessed using Kaplan-Meier curves. The evolution of the kidney donor type and the impact of DCDs on the total KT activity in Belgium were compared with the Netherlands. Between 2000 and 2009, 287 DCD KT were performed. Primary nonfunction occurred in 1% and DGF in 31%. Five-year patient and death-censored graft survival were 93% and 95%, respectively. In multivariate analysis, cold storage (versus machine perfusion), cold ischemic time, and histidine-tryptophan-ketoglutarate solution were independent risk factors for the development of DGF. Despite an increased number of DCD donations and transplantations, the total number of deceased KT did not increase significantly. This could suggest a shift from DBDs to DCDs. To increase KT activity, Belgium should further expand controlled DCD programs while simultaneously improve the identification of all potential DBDs and avoid their referral for donation as DCDs before brain death occurs. Furthermore, living donation remains underused.

There is little experience on the use of monoclonal antibodies that block the high-affinity interleukin-2 receptor (basiliximab and daclizumab) in sequential therapy in renal transplants with risk of delayed graft function. This study sougth to test the efficacy and safety of the substitution of anticalcineurins with two doses of basiliximab or daclizumab in the immediate posttransplant period for recipients at risk of delayed renal graft function. Immunosuppression consisted of steroids, mycophenolate mofetil, and two doses of basiliximab (20 mg/day) on days 0 and 4 posttransplant or daclizumab (1 mg/kg per day) on days 0 and 15 posttransplant. Anticalcineurins were not administered until the beginning of graft function. Among 49 recipients (mean age 63.5 Ϯ 10.5 years), 40 received a kidney from a donor over 60 years of age, three from a non-heart-beating donor, and six from donors with an acute elevation of serum creatinine to 2.4 Ϯ 0.86 (1.7-3.7). At a mean follow-up of 14.2 Ϯ 8.4 months, five patients experienced acute rejection episodes. Only 15 patients needed posttransplant dialysis (2.7 Ϯ 1.6). In 11 patients, cyclosporine (CsA) was introduced at 6 Ϯ 2.9 days posttransplant and in 37, tacrolimus on 8.6 Ϯ 3.6 days posttransplant. The incidence of kidney graft loss was 16.3%. Patient survival was 96%.

The effect of recipient hepatitis C virus (HCV) infection on renal allograft loss and acute rejection in kidney transplantation remains controversial. We studied 354 renal allograft recipients transplanted during 1996 to 2001 who had HCV antibodies (Ab) measured before transplantation. The primary outcome was death-censored allograft loss and the secondary outcome was acute humoral rejection (AHR). Compared with HCV Ab-negative patients, those with positive HCV Ab had longer time on dialysis before transplantation, higher percentage of panel-reactive antibodies (PRA), were more likely to receive a cadaveric transplant, and were more likely to develop delayed graft function (DGF). In univariate analyses, predictors of renal allograft loss included HCV, ca-daveric graft, PRA Ͼ20%, HLA mismatch Ն5, retransplantation, DGF, induction therapy, and AHR. When adjusted for PRA Ͼ20%, HLA mismatch Ն5, and multiple transplant status, HCV was not a statistically significant predictor of allograft loss. HCV was also associated with AHR but lost significance when adjusted for PRA Ͼ20%. HCV Ab-positive patients were more likely to have longer duration of dialysis before transplantation prior to kidney transplants, higher PRA, and to receive cadaveric transplants. These characteristics likely resulted in more DGF and AHR after transplantation. After adjusting for these confounding factors, the association between HCV Ab positivity and renal allograft loss was notably attenuated and no longer statistically significant.

The aim was to evaluate the effects of diagnostic performance of diffusionweighted (DW) MRI in the assessment of acute impairment of transplanted kidneys. Methods: From January 2009 to January 2010, 49 patients with stable renal allograft function (Group 1) and 21 patients with acute graft impairment (Group 2) were included in the study. All patients were evaluated with coronal T 2 weighted (T 2 W) and DW MRI of the kidney. Patients in Group 2 underwent graft biopsy to determine the underlying histopathological aetiology. Apparent diffusion coefficient (ADC) was calculated and the kidneys were studied for any areas of diffusion restriction. Two radiologists, who were blinded to the results of histopathology, independently interpreted the T 2 W and DW images. Results: The histopathological diagnosis ofGroup 2 (21 patients) was acute cellular rejection (ACR) in 10, acute tubular necrosis (ATN) in 7 and immunosuppressive toxicity in 4 patients. ADC values in Group 1 were significantly higher compared with Group 2 (p,0.001), patients with ACR (p,0.001), patients with ATN (p,0.001) and patients with drug toxicity (p,0.001). Using 2610 23 mm 2 s 21 as a cut-off, there was no overlap between the ADC values of patients with normal graft function and those with ATN. Both ACR and ATN had a low ADC value, but on the ADC map the kidney in cases of ATN appears heterogeneous with a characteristic mosaic pattern resembling the Tiger skin. There was no significant T 2 W morphological difference between the two groups. Conclusion: These results show how DW MRI is a promising new technique for the diagnosis of acute renal transplant dysfunction.

We studied registry data of 12,944 adult kidney retransplant recipients categorized by induction regimen received into antithymocyte globulin (ATG) (N = 9120), alemtuzumab (N = 1687), and basiliximab (N = 2137) cohorts. We analyzed risk factors for 1-year acute rejection (AR) and 5-year death-censored graft loss (DCGL) and patient death. Compared with the reference, basiliximab: (1) one-year AR risk was lower with ATG in retransplant recipients of expanded criteria deceased-donor kidneys (HR = 0.56, 95% CI = 0.35–0.91 and HR = 0.54, 95% CI = 0.27–1.08, resp.), while AR risk was lower with alemtuzumab in retransplant recipients with &gt;3 HLA mismatches before transplant (HR = 0.63, 95% CI = 0.44–0.93 and HR = 0.81, 95% CI = 0.63–1.06, resp.); (2) five-year DCGL risk was lower with alemtuzumab, not ATG, in retransplant recipients of African American race (HR = 0.54, 95% CI = 0.34–0.86 and HR = 0.73, 95% CI = 0.51–1.04, resp.) or with pretransplant glomerulonephritis (HR = 0.65, 95% C...

New immunosuppressive drugs used in kidney transplantation decreased the incidence of acute rejection. It was hypothesized that, with their power, the importance of HLA matching was decreased. To evaluate the influence of HLA matching, immunosuppression, and other possible risk factors, we analyzed data of 1314 consecutive deceased donor kidney transplantation. We divided the patient population into 4 cohorts, according to the era of transplantation: era 1, before 1990, azathioprine (Aza) and cyclosporine (Csa) no microemulsion; era 2, between 1990 and 1995, Csa microemulsion; era 3, between 1996 and 2000, wide use of mycophenolate mofetil (MMF) and anti-thymocyte globulin (ATG); and era 4, after 2000, marked by sirolimus and tacrolimus (TAC) use. Multivariate analysis compared death-censored graft survival. Using as reference the results obtained with 0 HLA mismatches, we verified, during era 1 and era 2, an increased risk of graft loss for all of the subgroups with HLA mismatch Ͼ0. However, during era 3 and era 4, the number of HLA mismatches did not influence graft survival. Although acute rejection and delayed graft function, which decreased in the later periods, remained as prognostic factors for graft loss. Considering the immunosuppressive protocol with CsaϩAzaϩPred as reference, protocols used after 1995 with PredϩCsaϩATG, with PredϩCsaϩMMF, and with PredϩTacϩMMF presented better survival results. Results showed that the significance of HLA matching decreased while the results improved with the new immunosuppressant drugs. These observations support the hypothesis that the weakened importance of HLA matching may be a consequence of the increasing efficacy of the immunosuppression. I T WAS shown several years ago, by the Collaborative Transplant Study, that there is a negative influence of human leukocyte antigen (HLA) mismatch between donor and recipient on kidney graft survival. 1 In this study, survival curves were clearly separated, corresponding better survival curves to lower number of HLA mismatches. Meanwhile, much has changed, especially in terms of immunosuppression. It is possible that, with the more

Background. Immunosuppressive agents have been investigated in renal ischaemia-reperfusion injury (IRI) and have frequently demonstrated a beneficial effect. Most studies focused on treatment of the recipient at the time of transplantation. Pre-treatment of these organs before injury (pharmacological pre-conditioning) may particularly protect these organs. This study aimed to investigate the possible protective effects of donor pre-treatment with cyclosporine (CsA) or the mTOR inhibitor everolimus or their combination against IRI during renal transplantation in a rat model. Methods. Donors received vehicle, CsA (5 mg/kg), everolimus (0.5 mg/kg) or CsA+everolimus. Two oral doses were administered to the donors at 24 h and again at 6 h prior to donor kidney removal. Syngeneic rat kidneys were preserved in UW solution for 24 h prior to transplantation. After 24 h of reperfusion, blood and tissue samples were collected from recipients for further analysis. Results. Renal functions as determined by creatinine and necrosis scores were not different between the experimental groups. Cleaved caspase-3, heat shock protein 70 (HSP70), tumor-necrosis factor-alpha (TNF-α) and nitrotyrosine protein levels were not statistically different between the four treatment groups at 24 h post-transplantation. Blood NMR analysis on metabolic markers for IRI reveals no beneficial effects of donor pre-treatment on the 24-h outcome in transplantation. Conclusions. When given alone or as a combination to donors before organ recovery, cyclosporine or everolimus does not appear to ameliorate IRI.

Indications for liver transplantation were as follows: hepatitis C cirrhosis (n=29); hepatitis B cirrhosis (n=13); cryptogenic cirrhosis (n=6); hepatitis B and C co-infection cirrhosis (n=1), primary biliary cirrhosis (n=1) and hepatocellular carcinoma (n=24). All patients were either on the KFSH waiting list for liver transplantation or were denied liver transplantation in KFSH or Egypt due to unsuitable medical condition such as old age or advanced hepatocellular carcinoma (HCC). One year, 3-year and 5-year cumulative patient survival rates were 83%, 62%, and 62% respectively compared to 92%, 84% and 71% in KFSH. Median survival time of the patients was signifi cantly less than that of those transplanted in KFSH (p=0.01). One year, 3-year and 5-year cumulative graft survival rates were 81%, 59%, and 59% respectively compared to 90%, 84% and 71% in KFSH. Of the surviving patients, many suffered from multiple other morbidities. Compared to the patients transplanted in KFSH, the incidence of complications was signifi cantly higher especially biliary complications (p=0.01), sepsis (p=0.003), rejection (p=0.04), metastasis (p=0.03) and acquired HBV infection posttransplant (p=0.02). In addition, requirement of postoperative interventions (radiologic and laparotomy) as well as hospital admissions, were signifi cantly higher hence constituting a higher burden on the resources of the hospital. Our data shows clearly that there is a high mortality and morbidity rate in Saudi and Egyptian patients receiving transplantation in China. This could be related to poor selection criteria, long warm ischemia time, or poor post transplant care. . Although cadaveric liver transplantation in China could be an option for desperate Egyptian and Saudi patients with end stage liver disease, patients and clinicians should be aware of the possible outcomes LATE BREAKING MINI-ORAL SESSION 30: