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Long-term Graft Outcome (long-term + graft_outcome)
Selected AbstractsTHE EFFECTS OF RENAL TRANSPLANT HISTOLOGY AT 3 MONTHS ON LONG-TERM GRAFT OUTCOMENEPHROLOGY, Issue 3 2000Fenton-Lee C [source] Alport syndrome: HLA association and kidney graft outcomeINTERNATIONAL JOURNAL OF IMMUNOGENETICS, Issue 3 2004S. Barocci Summary Alport syndrome (AS) is a genetic disease of type IV collagen involving non-homogeneous patterns of inheritance characterized clinically by the presence of progressive haematuric nephritis leading to end-stage renal disease (ESRD), hearing loss and/or ophthalmologic abnormalities. The aim of this study was to investigate, in a cohort of AS patients who had undergone a kidney graft (KG) or who were still on a waiting list for a KG, (a) whether there is a correlation between AS and HLA antigen expression, and (b) long-term graft outcome in transplant patients. The AS cohort was represented by 34 ESRD patients, of whom 25 received a KG and the remaining nine were still on a waiting list. AS transplant patients represented 2.78% of 899 first KGs performed at our centre (Transplantation Department at S. Martino Hospital, Genoa) between 1983 and 2002. Grafts were procured from cadaveric donors in 18 cases and from living, related donors in seven cases. All AS transplant patients had a post-transplant follow-up period of at least 12 months. Results showed that: (i) the frequency of the HLA-DRB1*16 antigen was significantly increased in the whole AS cohort as compared to 128 healthy subjects (HS) (corrected P -value 0.0026; relative risk 7.20) as well as to 232 non-AS ESRD patients on a waiting list for KG (corrected P -values 0.0156; relative risk 4.67); (ii) 5- and 10-year graft survivals in the AS transplant patients were 80 and 73%, respectively, and did not differ from those of a control group represented by 25 non-AS KG recipients matched for sex, age, number of HLA mismatches and immunosuppressive treatment. Increased frequency of HLA-DRB1*16 in AS patients may reflect a linkage disequilibrium with genes coding for collagen synthesis. [source] Improvement in Long-Term Renal Graft Survival due to CMV Prophylaxis with Oral Ganciclovir: Results of a Randomized Clinical TrialAMERICAN JOURNAL OF TRANSPLANTATION, Issue 5 2008V. Kliem Oral ganciclovir prophylaxis and intravenous preemptive therapy are competitive approaches to prevent cytomegalovirus (CMV) disease after renal transplantation. This trial compared efficacy, safety and long-term graft outcome in 148 renal graft recipients randomized to ganciclovir prophylaxis (N = 74) or preemptive therapy (N = 74). Hierarchical testing revealed (i) patients with CMV infection had more severe periods of impaired graft function (creatinine clearancemax-min 25.0 ± 14.2 mL/min vs. 18.1 ± 12.5 mL/min for patients without CMV infection; p = 0.02),(ii) prophylaxis reduced CMV infection by 65% (13 vs. 33 patients; p < 0.0001) but (iii) creatinine clearance at 12 months was comparable for both regimes (54.0 ± 24.9 vs. 53.1 ± 23.7 mL/min; p = 0.92). No major safety issues were observed, and patient survival at 12 months was similar in both groups (5 deaths [6.8%] vs. 4 [5.4%], p = 1.0000). Prophylaxis significantly increased long-term graft survival 4 years posttransplant (92.2% vs. 78.3%; p = 0.0425) with a number needed to treat of 7.19. Patients with donor +/recipient + CMV serostatus had the lowest rate of graft loss following prophylaxis (0.0% vs. 26.8%; p = 0.0035). In conclusion, it appears that routine oral prophylaxis may improve long-term graft survival for most renal transplant patients. Preemptive therapy can be considered in low risk patients in combination with adequate CMV monitoring. [source] Risk Factors and Long-Term Outcome of Transplant Renal Artery Stenosis in Adult Recipients After Treatment by Percutaneous Transluminal AngioplastyAMERICAN JOURNAL OF TRANSPLANTATION, Issue 1 2006V. Audard Transplant renal artery stenosis (TRAS) is a common complication of kidney transplantation but attempts to identify predisposing risk factors for TRAS have yielded conflicting results. In order to determine the predisposing factors for transplant (TRAS), we retrospectively reviewed the records of 29 renal allograft recipients with TRAS treated with percutaneous transluminal angioplasty (PTA). The TRAS group was compared with a case-control group of 58 patients. Predisposing factors for TRAS included CMV infection (41.4% vs. 12.1% p = 0.0018) and initial delayed graft function (DGF) (48.3% vs. 15.5% p = 0.0018), respectively in the TRAS and the control group. Acute rejection occurred more frequently in patients from the TRAS group (48.3%) compared with the control group (27.6%), although the difference was not significant (p = 0.06). In a multivariate analysis, only CMV infection (p = 0.005) and DGF (p = 0.009) appear to be significantly and independently associated with TRAS. The long-term graft survival was significantly higher in the control group, compared with the TRAS group (p = 0.03). Our study suggests that CMV infection and DGF are two reliable risk factors for TRAS. Despite treatment by PTA with primary successful results, TRAS significantly affects long-term graft outcome. [source] Cold ischaemia time added to kidneys can be minimized by completing the final cross-match before organs are taken from the operating roomCLINICAL TRANSPLANTATION, Issue 2003Christopher F Bryan Abstract:,Purpose: Minimizing the amount of cold ischaemia time (CIT) added to cadaveric kidneys before their transplantation is an important goal since longer CIT is associated with worse long-term graft outcome. Our organ procurement organization (OPO) and HLA laboratories have taken the approach of performing the histocompatibility testing, including the final cross-match, as early in the donor process as possible. Methods: The data in this study were collected from all consecutive final cross-matches done for cadaveric kidney (n = 113) and simultaneous pancreas + kidney (SPK) (n = 25) transplants done with organs recovered from donors in the Midwest Transplant Network OPO from 1 January 2001 to 9 May 2002. We evaluated the time the final cross-match was completed from when the kidneys from that donor were taken from the operating room (OR) and compared that time with CIT. Results: For kidney transplants, 72% of the final cross-matches were complete before the kidneys were taken from the OR. The CIT of that group (10.4 ± 3.8 h) was significantly lower than that of the group of kidney transplant patients whose final cross-match was done after the kidneys were taken from the OR (15.5 ± 5.8 h) (P < 0.001). Similarly, for SPK transplants, 88% of the final cross-matches were completed before the organs left the OR and the CIT of that group (10.2 ± 3.4 h) was less than in the group whose final cross-match was done after the organs left the OR (14.3 ± 4.8 h) (P > 0.1). Conclusions: These data show that the practice of completing the final cross-match as early in the donor process as possible helps to minimize the amount of cold ischaemia time added to the kidneys and pancreata before transplantation. That should reduce the detrimental influence that longer CIT has on short- and long-term function in kidney as well as SPK transplantation. [source] Tacrolimus withdrawal and conversion to sirolimus at three months post-pediatric renal transplantationPEDIATRIC TRANSPLANTATION, Issue 7 2008Leonard C. Hymes Abstract:, Nephrotoxicity caused by CNI may adversely affect long-term graft outcomes. For this reason, we have adopted a protocol for withdrawing TAC and converting to SRL at three months post-renal transplantation. All recipients received basiliximab induction and TAC, MMF, and prednisone. Patients without acute rejection by surveillance biopsy at three months were eligible for SRL conversion. Results: From August 2004 to September 2006, TAC was withdrawn and replaced by SRL in 30 first transplant recipients, who were followed for six to 39 months (mean 18 ± 8). Renal function did not improve significantly after SRL conversion (p = 0.25). Acute rejection occurred in three patients (10%) at five to 12 months after CNI withdrawal. There were no occurrences of wound healing problems, pneumonitis or post-transplant lymphoproliferative disease. Thrombocytopenia and diabetes each occurred in one patient. Four patients received treatment for hypercholesterolemia. CNI withdrawal and replacement with SRL was an effective regimen in children who did not display biopsy evidence of acute rejection at three months post-transplant. While these early results are promising, the ultimate benefit of this protocol to enhance the long-term renal function and graft survival requires ongoing follow-up. [source] Composite Tissue Vasculopathy and Degeneration Following Multiple Episodes of Acute Rejection in Reconstructive TransplantationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 2 2010J. V. Unadkat Transplant vasculopathy has not been systematically investigated in composite tissue allotransplantation (CTA). The impact of multiple acute rejections (ARs) on long-term graft outcomes in reconstructive transplantation remains unknown. This study in a rat hind-limb allotransplantation model systematically analyzes vasculopathy and tissue-specific pathological changes secondary to multiple AR episodes. LEW rats were transplanted with BN rat hind limbs and treated as follows: Group 1 (Iso): isografts. Group 2 (CsA): Cyclosporine (CsA) qd; Group 3 (mult AR): CsA and dexamethasone only when AR was observed. No AR was observed in Groups 1 and 2. Multiple AR were observed in Group 3, and each episode was completely reversed (clinically) with pulsed CsA + dexamethasone treatment. Group 3 animals demonstrated significant vascular lesions along with skin and muscle atrophy, upregulation of profibrotic gene expression and fibrosis when compared to Groups 1 and 2. In addition, allograft bone was sclerotic, weak and prone to malunion and nonunion. Interestingly, vasculopathy was a late finding, whereas muscle atrophy with macrophage infiltration was seen early, after only a few AR episodes. Taken together, multiple AR episodes lead to vasculopathy and tissue-specific pathology in CTA. This is the first evidence of ,composite tissue vasculopathy and degeneration (CTVD)' in CTA. [source] | ||||||||||