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Garland S, Pullerits K, Chukwu CA, Chinnadurai R, Middleton R, Kalra PA. The effect of primary renal disease upon outcomes after renal transplant. Clin Transplant 2024; 38:e15216. [PMID: 38450843 DOI: 10.1111/ctr.15216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 11/22/2023] [Accepted: 11/25/2023] [Indexed: 03/08/2024]
Abstract
BACKGROUND This study investigated whether nature of primary renal disease affects clinical outcomes after renal transplantation at a single center in the United Kingdom. METHODS This was a retrospective cohort study of 961 renal transplant recipients followed up at a large renal center from 2000 to 2020. Separation of diseases responsible for end-stage kidney disease included glomerulonephritis, diabetic kidney disease, hypertensive nephropathy, autosomal dominant polycystic kidney disease, unknown cause, other causes and chronic pyelonephritis. Outcome data included graft loss, cardiovascular events, malignancy, post-transplant diabetes mellitus and death, analyzed according to primary disease type. RESULTS The mean age at transplantation was 47.3 years. During a mean follow-up of 7.6 years, 18% of the overall cohort died corresponding to an annualised mortality rate of 2.3%. Death with a functioning graft occurred at a rate of 2.1% per annum, with the highest incidence observed in in patients with diabetic kidney disease (4.1%/year). Post-transplant cardiovascular events occurred in 21% of recipients (2.8% per year), again highest in recipients with diabetic kidney disease (5.1%/year) and hypertensive nephropathy (4.5%/year). Post-transplant diabetes mellitus manifested in 19% of the cohort at an annualized rate of2.1% while cancer incidence stood at 9% with an annualized rate of 1.1% . Graft loss occurred in 6.8% of recipients at the rate of1.2% per year with chronic allograft injury, acute rejection and recurrent glomerulonephritis being the predominant causative factors. Median + IQR dialysis-free survival of the whole cohort was 16.2 (9.9 - > 20) years, being shortest for diabetic kidney disease (11.0 years) and greatest for autosomal dominant polycystic kidney disease (18.2 years) .The collective mean decline in eGFR over time was -1.14ml/min/year. Recipients with Pre-transplant diabetic kidney disease exhibited the fastest rate of decline(-2.1ml/min/year) a statistically significant difference in comparison to the other native kidney diseases with Autosomal dominant polycystic kidney disease exhibiting the lowest rate of decline(-0.05ml/min/year) CONCLUSION: Primary renal disease can influence the outcome after renal transplantation, with patients with prior diabetic kidney disease having the poorest outcome in terms of dialysis-free survival and loss of transplant function. Autosomal polycystic kidney disease, other cause and unknown cause had the best outcomes compared to other primary renal disease groups.
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Affiliation(s)
| | | | - Chukwuma A Chukwu
- Faculty of Biology, Medicine and Health, Division of cardiovascular medicine, The University of Manchester, Manchester, UK
- Department of Nephrology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Rajkumar Chinnadurai
- Faculty of Biology, Medicine and Health, Division of cardiovascular medicine, The University of Manchester, Manchester, UK
- Department of Nephrology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Rachel Middleton
- Faculty of Biology, Medicine and Health, Division of cardiovascular medicine, The University of Manchester, Manchester, UK
- Department of Nephrology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Philip A Kalra
- Faculty of Biology, Medicine and Health, Division of cardiovascular medicine, The University of Manchester, Manchester, UK
- Department of Nephrology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
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Outcome of Renal Transplantation in Patients With Diabetes Mellitus: A Single-Center Experience. Transplant Proc 2022; 54:2174-2178. [PMID: 36195495 DOI: 10.1016/j.transproceed.2022.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/02/2022] [Accepted: 08/26/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND An increasing proportion of kidney recipients have diabetes mellitus (DM). Some concerns have been raised about the kidney transplantation results in diabetic patients. Therefore, we assessed the effect of DM on morbidity and mortality of diabetic patients with renal transplantation. METHODS We retrospectively studied adult patients with and without DM who underwent living donor transplantation between 2007 and 2016. Information concerning demographic and clinical data were retrospectively analyzed by reviewing the patient files. RESULTS Of the 1536 transplant recipients, 126 (8%) had diabetes mellitus (mean age 49.4 ± 11.8) and 525 patients were evaluated in the non-diabetic control group (mean age 36.2 ± 15.9). The diabetic and non-diabetic patient groups had a mean follow-up after kidney transplantation 42.5 months (0.27-101.7 months) and 58.8 ± 10.6 months, respectively. In the diabetic patient group, only 3 patients had lost graft and 13 patients were exitus. Three patients had lost graft and 5 patients were exitus in non-diabetic patient group. Cardiac death (54.5%) was the most common cause of mortality in diabetic group. The 6-year patient and graft survival rates are 84.9% and 95.3%; 97.5% and 97.2% in the diabetic and non-diabetic patient groups, respectively. CONCLUSIONS Both infection and cardiovascular diseases increase morbidity and mortality in renal transplant patients with diabetes mellitus. The mortality risk of diabetic patients after renal transplantation is higher than the non-diabetic kidney recipients. Therefore, diabetic patients need meticulous cardiac evaluation before renal transplantation and a close follow-up, in terms of infection, after transplantation.
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Shuster S, Al-Hadhrami Z, Moore S, Awad S, Shamseddin MK. Use of Sodium-Glucose Cotransporter-2 Inhibitors in Renal Transplant Patients With Diabetes: A Brief Review of the Current Literature. Can J Diabetes 2021; 46:207-212. [PMID: 34362679 DOI: 10.1016/j.jcjd.2021.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 06/13/2021] [Accepted: 06/14/2021] [Indexed: 11/28/2022]
Abstract
Sodium-glucose cotransporter-2 (SGLT2) inhibitors are a novel class of oral hypoglycemic agents commonly prescribed in type 2 diabetes (T2D). They have been shown to slow the progression of diabetic nephropathy and improve cardiovascular outcomes in high-risk individuals, although major cardiovascular and renal outcome clinical trials have excluded renal transplant patients. The aim of this review was to determine the outcomes and safety with use of SGLT2 inhibitors in renal transplant patients with diabetes. We conducted a review of randomized controlled trials, cohort studies, case series and case reports that assessed use of SGLT2 inhibitors in patients post-renal transplant with either pre-existing T2D or new-onset diabetes after transplant. The outcomes assessed included blood pressure, renal allograft function (estimated glomerular filtration rate), proteinuria (urinary albumin-to-creatinine ratio), glycemic control, body weight and adverse effects. A total of 9 studies, which included 144 patients, were reviewed. SGLT2 inhibitor use in renal transplant patients demonstrates either a small or nonsignificant reduction in blood pressure and results in overall stable renal allograft function. It also results in modest improvement in glycemic control as well as weight reduction. The incidence of adverse effects is low and reversible, as reported in previous nontransplant clinical trials. Overall, our findings suggest beneficial outcomes with no significant adverse effects or complications with the use of SGLT2 inhibitors in renal transplant patients with diabetes; however, these findings are based on small trials, and thus well-designed trials in this population are warranted.
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Affiliation(s)
- Shirley Shuster
- Department of Medicine, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada
| | - Zeyana Al-Hadhrami
- Department of Medicine, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada; Division of Nephrology, Department of Medicine, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada
| | - Sarah Moore
- Department of Medicine, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada; Division of Endocrinology, Department of Medicine, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada
| | - Sara Awad
- Department of Medicine, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada; Division of Endocrinology, Department of Medicine, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada
| | - M Khaled Shamseddin
- Department of Medicine, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada; Division of Nephrology, Department of Medicine, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada.
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Sadat B, Tirunagari D, Karthikeyan V, Patel A, Van Harn M, Saleem MM, Ananthasubramaniam K. Clinical impact of pre-kidney transplant pulmonary hypertension on post-transplant outcomes. Int J Cardiovasc Imaging 2021; 37:1979-1986. [PMID: 33616784 DOI: 10.1007/s10554-021-02182-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 01/30/2021] [Indexed: 11/25/2022]
Abstract
Outcomes of kidney transplant (KT) patients with pre-transplant pulmonary hypertension (PH) are poorly understood. PH patients are often considered high risk and excluded from KT. We investigated the association of pre-transplant PH with KT recipient's outcomes. A single-center, retrospective study that reviewed all patients transplanted from 2010 to 2016, who had a transthoracic echocardiogram (TTE) before KT and at least one TTE post-KT. The TTE closest to the KT was used for analyses. PH is defined as pulmonary artery systolic pressure (PASP) ≥ 40 mm Hg. Of 204 patients, 61 had PASP ≥ 40 mm Hg (with PH) and 143 had PASP < 40 mm Hg (without PH) prior to KT. No statistically significant differences existed between the two groups in baseline demographics, renal failure etiologies, dialysis access type, and cardiovascular risk factors. The mean difference in pre-KT PASP was 18.1 ± 7 mm Hg (P < 0.001). Patients with PH had a statistically significant decrease in PASP post-KT compared to the patients without PH with a mean change of -7.03 ± 12.28 mm Hg vs. + 3.96 ± 11.98 mm Hg (p < 0.001), respectively. Moderate mitral and moderate-severe tricuspid regurgitation were the only factors found to be independently associated with PH (p = 0.001) on multivariable analysis. No statistically significant difference was notable in patient survival, graft function, and creatinine post-KT in both groups. PH pre-KT particularly mild-moderate PH did not adversely affect intermediate (90-day) and long-term allograft and patient survival. Patients with mild-moderate PH should not be excluded from KT.
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Affiliation(s)
- Besher Sadat
- Department of Hospital Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Deepthi Tirunagari
- Department of Cardiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI, USA
| | | | - Anita Patel
- Department of Nephrology, Henry Ford Hospital, Detroit, MI, USA
| | - Meredith Van Harn
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - M Mariam Saleem
- Department of Hospital Medicine, Henry Ford Hospital, Detroit, MI, USA
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Chan Chun Kong D, Akbari A, Malcolm J, Doyle MA, Hoar S. Determinants of Poor Glycemic Control in Patients with Kidney Transplants: A Single-Center Retrospective Cohort Study in Canada. Can J Kidney Health Dis 2020; 7:2054358120922628. [PMID: 32477582 PMCID: PMC7235535 DOI: 10.1177/2054358120922628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/27/2020] [Indexed: 12/21/2022] Open
Abstract
Background: Kidney transplant immunosuppressive medications are known to impair glucose metabolism, causing worsened glycemic control in patients with pre-transplant diabetes mellitus (PrTDM) and new onset of diabetes after transplant (NODAT). Objectives: To determine the incidence, risk factors, and outcomes of both PrTDM and NODAT patients. Design: This is a single-center retrospective observational cohort study. Setting: The Ottawa Hospital, Ontario, Canada. Participant: A total of 132 adult (>18 years) kidney transplant patients from 2013 to 2015 were retrospectively followed 3 years post-transplant. Measurements: Patient characteristics, transplant information, pre- and post-transplant HbA1C and random glucose, follow-up appointments, complications, and readmissions. Methods: We looked at the prevalence of poor glycemic control (HbA1c >8.5%) in the PrTDM group before and after transplant and compared the prevalence, follow-up appointments, and rate of complications and readmission rates in both the PrTDM and NODAT groups. We determined the risk factors of developing poor glycemic control in PrTDM patients and NODAT. Student t-test was used to compare means, chi-squared test was used to compare percentages, and univariate analysis to determine risk factors was performed by logistical regression. Results: A total of 42 patients (31.8%) had PrTDM and 12 patients (13.3%) developed NODAT. Poor glycemic control (HbA1c >8.5%) was more prevalent in the PrTDM (76.4%) patients compared to those with NODAT (16.7%; P < .01). PrTDM patients were more likely to receive follow-up with an endocrinologist (P < .01) and diabetes nurse (P < .01) compared to those with NODAT. There were no differences in the complication and readmission rates for PrTDM and NODAT patients. Receiving a transplant from a deceased donor was associated with having poor glycemic control, odds ratio (OR) = 3.34, confidence interval (CI = 1.08, 10.4), P = .04. Both patient age, OR = 1.07, CI (1.02, 1.3), P < .01, and peritoneal dialysis prior to transplant, OR = 4.57, CI (1.28, 16.3), P = .02, were associated with NODAT. Limitations: Our study was limited by our small sample size. We also could not account for any diabetes screening performed outside of our center or follow-up appointments with family physicians or community endocrinologists. Conclusion: Poor glycemic control is common in the kidney transplant population. Glycemic targets for patients with PrTDM are not being met in our center and our study highlights the gap in the literature focusing on the prevalence and outcomes of poor glycemic control in these patients. Closer follow-up and attention may be needed for those who are at risk for worse glycemic control, which include older patients, those who received a deceased donor kidney, and/or prior peritoneal dialysis.
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Affiliation(s)
| | - Ayub Akbari
- Faculty of Medicine, University of Ottawa, ON, Canada.,Division of Nephrology, The Ottawa Hospital, ON, Canada
| | - Janine Malcolm
- Faculty of Medicine, University of Ottawa, ON, Canada.,Division of Endocrinology, The Ottawa Hospital, ON, Canada
| | - Mary-Anne Doyle
- Faculty of Medicine, University of Ottawa, ON, Canada.,Division of Endocrinology, The Ottawa Hospital, ON, Canada
| | - Stephanie Hoar
- Faculty of Medicine, University of Ottawa, ON, Canada.,Division of Nephrology, The Ottawa Hospital, ON, Canada
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Jarmi T, Doumit E, Makdisi G, Mhaskar R, Miladinovic B, Wadei H, Rumbak M, Aslam S. Pulmonary Artery Systolic Pressure Measured Intraoperatively by Right Heart Catheterization Is a Predictor of Kidney Transplant Recipient Survival. Ann Transplant 2018; 23:867-873. [PMID: 30559336 PMCID: PMC6319438 DOI: 10.12659/aot.911176] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The effect of pulmonary artery systolic pressure (PASP) measured by Swan-Ganz right heart catheter (SG-RHC) on kidney transplant recipient survival has not been previously studied. The objective of this study was to assess the relationships between PASP measured via SG-RHC, done intraoperatively at the time of initiating anesthesia at the beginning of kidney transplant surgery, and patient survival. Multiple comorbidities, time on dialysis before the transplantation, and graft function were also analyzed in our study. MATERIAL AND METHODS This was a retrospective cohort study using data from all consecutive patients undergoing kidney transplant between January 1, 2005 and December 31, 2009 at Tampa General Hospital. Kidney transplant recipients were divided into 2 groups: Group 1 with PASP <35 mmHg and group 2 with PASP ≥35 mmHg. Patients and graft survival data, time on dialysis before transplant, and comorbidities were compared between the 2 groups. RESULTS Only 363 patients were found to have a documented PASP measurement at the time of anesthesia induction for the transplant surgery, and were included in the specific analysis of our study. Patients with PASP ≥35 mmHg showed a significant decrease in survival in comparison to patients having PASP values <35 mmHg (HR 1.88; 95% CI 1.012 to 3.47, P=0.04). There was a significant positive correlation between time on dialysis and PASP (rho 0.20; 95% CI 0.09 to 0.30, p<0.001), as well as a significant difference in median time on dialysis between PASP <35 vs. PASP ≥35 (22 vs. 29 months, p=0.004). There were no significant differences in graft failure between the 2 PASP groups (HR 0.34; 95% CI 0.12 to 1.01, P=0.05). CONCLUSIONS Patients with PASP ≥35 mmHg, measured intraoperatively by SG-RHC, showed significantly shorter survival in comparison to patients having PASP values <35 mmHg. This result suggests the need for a randomized controlled trial to address the importance of post-transplant pulmonary hypertension management in patient survival.
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Affiliation(s)
- Tambi Jarmi
- Division of Nephrology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Elias Doumit
- Division of Nephrology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - George Makdisi
- Department of Surgery, Division of Thoracic and Cardiovascular, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Rahul Mhaskar
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Branko Miladinovic
- Program for Comparative Effectiveness Research and Evidence-Based Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Hani Wadei
- Transplant Center, Mayo Clinic, Jacksonville Campus, Jacksonville, FL, USA
| | - Mark Rumbak
- Department of Pulmonary Critical Care and Sleep Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Sadaf Aslam
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
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Baek CH, Kim H, Baek SD, Jang M, Kim W, Yang WS, Han DJ, Park SK. Outcomes of living donor kidney transplantation in diabetic patients: age and sex matched comparison with non-diabetic patients. Korean J Intern Med 2018; 33:356-366. [PMID: 28823116 PMCID: PMC5840590 DOI: 10.3904/kjim.2016.067] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 05/24/2016] [Accepted: 05/30/2016] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Kidney transplantation (KT) reportedly provides a significant survival advantage over dialysis in diabetic patients. However, KT outcome in diabetic patients compared with that in non-diabetic patients remains controversial. In addition, owing to recent improvements in the outcomes of KT and management of cardiovascular diseases, it is necessary to analyze outcomes of recently performed KT in diabetic patients. METHODS We reviewed all diabetic patients who received living donor KT between January 2008 and December 2011. Each patient was age- and sex-matched with two non-diabetic patients who received living donor KT during the same period. The outcomes of living donor KT were compared between diabetic and non-diabetic patients. RESULTS Among 887 patients, 89 diabetic patients were compared with 178 non-diabetic patients. The incidence of acute rejection was not different between the diabetic and non-diabetic patients. Urinary tract infection and other infections as well as cardiovascular events occurred more frequently in diabetic patients. However, diabetes, cardiovascular disease, and infection were not significant risk factors of graft failure. Late rejection (acute rejection after 1 year of transplantation) was the most important risk factor for graft failure after adjusting for diabetes mellitus (DM), human leukocyte antigen mismatch, rejection and infection (hazard ratio, 56.082; 95% confidence interval, 7.169 to 438.702; p < 0.001). Mortality was not significantly different between diabetic and non-diabetic patients (0 vs. 2, p = 0.344 by log-rank test). CONCLUSIONS End-stage renal disease patients with DM had favorable outcomes with living donor kidney transplantation.
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Affiliation(s)
- Chung Hee Baek
- Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyosang Kim
- Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Don Baek
- Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mun Jang
- Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Wonhak Kim
- Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Seok Yang
- Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Duck Jong Han
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Su-Kil Park
- Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Kim CS. Kidney transplantation in patients with diabetes: better than nothing. Korean J Intern Med 2018; 33:293-294. [PMID: 29506342 PMCID: PMC5840602 DOI: 10.3904/kjim.2018.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 01/24/2018] [Indexed: 01/23/2023] Open
Affiliation(s)
- Chang Seong Kim
- Correspondence to Chang Seong Kim, M.D. Department of Internal Medicine, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju 61469, Korea Tel: +82-62-220-6254 Fax: +82-62-225-8578 E-mail:
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9
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Clinical outcome of type 2 diabetic patients after kidney transplantation: Systematic review. INDIAN JOURNAL OF TRANSPLANTATION 2017. [DOI: 10.1016/j.ijt.2016.09.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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10
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Can Ö, Kasapoğlu U, Boynueğri B, Tuğcu M, Çağlar Ruhi B, Canbakan M, Murat Gökçe A, Ata P, İzzet Titiz M, Apaydın S. Factors Affecting the Selection of Patients on Waiting List: A Single Center Study. Transplant Proc 2016; 47:1265-8. [PMID: 26093695 DOI: 10.1016/j.transproceed.2015.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION There is an increasing gap between organ supply and demand for cadaveric transplantation in our country. Our aim was to evaluate factors affecting selection of patients on waiting list at our hospital. METHOD Patients who have been waiting on list and who were transplanted were compared in order to find factors, which affected the selection of patients. Non-parametric Mann-Whitney U test was used for comparison and cox regression analysis was used to find the risk factors that decrease the probability of transplantation in this retrospective case-control study. RESULTS Patients in the transplanted group were significantly younger, had relatively lower body mass index than the awaiting group. Cardiovascular diseases were more in the awaiting group than the transplanted group. There was no patient with diabetes in transplanted group, despite fifteen diabetic patients were in the awaiting group. Selected patients had lower immunologic risk with regard to peak panel reactive antibody levels. No significant difference was found for gender, hypertension, hyperlipidemia, viral serology, time spent on dialysis and on waiting list between two groups. With cox regression analysis female gender, older age, diabetes mellitus, high body mass index, positive hepatitis B serology and high levels of peak class 1-2 peak panel reactive antibody positivity were found as risk factors that decrease the probability of transplantation. CONCLUSION A tendency for selection of low risk patients was found with this study. Time and energy consuming complications and short allograft survival after transplantation in high risk patients and the scarcity of cadaveric pool in our country may contribute to this tendency.
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Affiliation(s)
- Ö Can
- Department of Nephrology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.
| | - U Kasapoğlu
- Department of Nephrology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - B Boynueğri
- Department of Nephrology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - M Tuğcu
- Department of Nephrology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - B Çağlar Ruhi
- Department of Nephrology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - M Canbakan
- Department of Nephrology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - A Murat Gökçe
- Department of General Surgery and Transplantation, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - P Ata
- Genetic Diseases Diagnosis Center, Molecular Genetics Laboratory, Haydarpasa Numune Research and Training Hospital, Istanbul, Turkey
| | - M İzzet Titiz
- Department of General Surgery and Transplantation, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - S Apaydın
- Department of Nephrology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
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Suzuki T, Nakao T, Harada S, Nakamura T, Koshino K, Sakai K, Nobori S, Ito T, Ushigome H, Yoshimura N. Results of Kidney Transplantation for Diabetic Nephropathy: A Single-Center Experience. Transplant Proc 2014; 46:464-6. [DOI: 10.1016/j.transproceed.2013.11.076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 11/22/2013] [Indexed: 10/25/2022]
Affiliation(s)
- T Suzuki
- Division of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - T Nakao
- Division of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - S Harada
- Division of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - T Nakamura
- Division of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - K Koshino
- Division of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - K Sakai
- Division of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - S Nobori
- Division of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - T Ito
- Division of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - H Ushigome
- Division of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - N Yoshimura
- Division of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Choi J, Kwon O. Post-Transplant Diabetes Mellitus: Is It Associated With Poor Allograft Outcomes in Renal Transplants? Transplant Proc 2013; 45:2892-8. [DOI: 10.1016/j.transproceed.2013.08.067] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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13
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Kidney Transplantation in Type 2 Diabetic Patients: A Matched Survival Analysis. Transplant Proc 2013; 45:2141-6. [DOI: 10.1016/j.transproceed.2012.11.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 09/23/2012] [Accepted: 11/08/2012] [Indexed: 12/11/2022]
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He D, Li J, Zhao J, Fei J, Zhang X. C/EBP homologous protein induces mesangial cell apoptosis under hyperglycemia. Mol Med Rep 2012; 7:445-8. [PMID: 23241730 DOI: 10.3892/mmr.2012.1234] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 12/07/2012] [Indexed: 11/06/2022] Open
Abstract
Diabetes mellitus is known to cause kidney impairment; however, the mechanism remains elusive. The aim of this study was to investigate the role of C/EBP homologous protein (CHOP), an important protein in endoplasmic reticulum stress‑mediated mesangial cell apoptosis in hyperglycemia. Mesangial cells were cultured in normal (control group) and high glucose medium (high glucose group). TUNEL staining was performed to assess apoptotic cells in the groups. The expression of CHOP and caspase‑3 was also assayed by immunohistochemistry and western blot analysis. Following 24 h culture in high glucose medium, TUNEL‑positive cells were observed to be significantly increased (P<0.01). The expression of CHOP and caspase‑3 in mesangial cells was also found to be significantly enhanced under high glucose conditions compared with the normal group (P<0.01). The results indicate that CHOP mediates apoptosis in mesangial cells under hyperglycemia and may play a role in the development of diabetic nephropathy.
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Affiliation(s)
- Daqiang He
- Department of Anatomy and Cell Biology, School of Medicine, Zhejiang University, Zhejiang 310058, P.R. China
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