1
|
Predmore Z, Doby B, Bozzi DG, Durand C, Segev D, Sugarman J, Tobian AA, Wu AW. Barriers experienced by organ procurement organizations in implementing the HOPE act and HIV-positive organ donation. AIDS Care 2022; 34:1144-1150. [PMID: 34180726 PMCID: PMC8725194 DOI: 10.1080/09540121.2021.1945999] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 06/16/2021] [Indexed: 01/26/2023]
Abstract
In the seven years since the HIV Organ Policy Equity (HOPE) Act made HIV-positive organ donation to HIV-positive recipients legally permissible in the United States, there have been fewer HIV-positive organ donations than expected. Organ procurement organizations (OPOs) play a key role in the transplant system and barriers at OPOs may be partly responsible for the relatively low number of HIV-positive donors. To understand potential OPO barriers, we conducted semi-structured interviews with 20 OPO staff members. Interviews were recorded, transcribed, and analyzed using a conventional content analytic approach with two coders. OPO staff had high levels of knowledge about HOPE. Many had evaluated referrals of HIV-positive donors and approached families for authorization. Barriers to HIV-positive organ recovery identified included obtaining authorization for donation, potentially disclosing HIV status to next-of-kin, and fear of HIV infection among those engaged in organ recovery. Strategies to overcome these barriers include providing continuing education about the specific tasks required to procure organs from HIV-positive donors, implementing targeted interventions to reduce fear of infection, and developing partnerships with HIV advocacy and care organizations. Given the central role OPOs play, HIV-positive donations are unlikely to occur in significant numbers unless these barriers can be overcome.
Collapse
Affiliation(s)
- Zachary Predmore
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, MD
| | | | - Debra G. Bozzi
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, MD
| | - Christine Durand
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dorry Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jeremy Sugarman
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, MD
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD
| | - Aaron A.R. Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Albert W. Wu
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, MD
| |
Collapse
|
2
|
Bansal S, Rupala KG, Ghosh P, Khera R, Kumar D, Ahlawat R. Comparison of estimated glomerular filtration rate of marginal versus standard renal allograft: A prospective cohort study. Indian J Urol 2021; 37:241-246. [PMID: 34465953 PMCID: PMC8388334 DOI: 10.4103/iju.iju_32_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/31/2021] [Accepted: 06/21/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction: The end-stage renal disease (ESRD) population is increasing worldwide and organ shortage is an important issue. The disparity between the availability of organs and waitlisted patients for transplants has forced many transplant centers across the world to use marginal kidney donors. We assess and compare postoperative estimated glomerular filtration rate (eGFR) in patients who received a graft from marginal renal donor (MRD) versus those who received a graft from standard renal donor (SRD). Methods: A total of 214 patients with ESRD underwent open live donor renal allografting from September 2015 to September 2017. Out of 214 donors, 165 (77.1%) were SRD and 49 (22.9%) were MRD. Post-transplant eGFR was calculated at 2 months for donors and at days 1, 3, 5, and 7 and month 1, 3, 6, and 12 for recipients. Results: There was no statistically significant difference in eGFR of recipients at preoperative and postoperative period between SRD and MRD groups. Although at 12 months of follow–up eGFR was relatively high in SRD group, it did not show any statistically significant difference. The recipient survival rate at 1-year follow-up was 98.2% in SRD and 100% in MRD group. Conclusions: Renal transplant recipients using MRDs have a comparable glomerular filtration rate to SRDs at the end of 1 year. Short-term outcomes in recipients receiving marginal renal grafts were similar when compared to the allograft from standard donors.
Collapse
Affiliation(s)
- Somendra Bansal
- Department of Urology and Renal Transplant, SMS Medical College, Jaipur, Rajasthan, India
| | | | - Prasun Ghosh
- Kidney and Urology Institute, Medanta - The Medicity, Gurugram, Haryana, India
| | - Rakesh Khera
- Kidney and Urology Institute, Medanta - The Medicity, Gurugram, Haryana, India
| | - Deepak Kumar
- Kidney and Urology Institute, Medanta - The Medicity, Gurugram, Haryana, India
| | - Rajesh Ahlawat
- Kidney and Urology Institute, Medanta - The Medicity, Gurugram, Haryana, India
| |
Collapse
|
3
|
Yoshinaga K, Araki M, Wada K, Sekito T, Watari S, Maruyama Y, Mitsui Y, Sadahira T, Kubota R, Nishimura S, Edamura K, Kobayashi Y, Tanabe K, Takeuchi H, Kitagawa M, Kitamura S, Wada J, Watanabe M, Watanabe T, Nasu Y. Feasible kidney donation with living marginal donors, including diabetes mellitus. IMMUNITY INFLAMMATION AND DISEASE 2021; 9:1061-1068. [PMID: 34102025 PMCID: PMC8342240 DOI: 10.1002/iid3.470] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/23/2021] [Accepted: 05/24/2021] [Indexed: 11/19/2022]
Abstract
Objectives To compare the donor outcomes of living donor kidney transplantation between standard donors (SDs) and marginal donors (MDs) including diabetic patients (MD + DM). Methods MDs were defined according to Japanese guideline criteria: (a) age >70‐years, (b) blood pressure ≤130/80 mmHg on hypertension medicine, (c) body mass index >25 to ≤32 kg/m2, (d) 24‐h creatinine clearance ≥70 to <80 ml/min/1.73 m2, and (e) hemoglobin A1c > 6.2 or ≤6.5 with oral diabetic medicine. Fifty‐three of 114 donors were MDs. We compared donor kidney functions until 60 months postoperatively. Results No kidney function parameters were different between SDs and MDs. When comparing SD and MD + DM, MD + DM had a lower postoperative eGFR (48 vs. 41 (1 (month), p = .02), 49 vs. 40 (12, p < .01), 48 vs. 42 (24, p = .04), 47 vs. 38 (36, p = .01)) and the percentage of residual eGFR (SD vs. MD + DM: 63 vs. 57 (1 (month), p < .01), 63 vs. 57 (2, p < .01), 64 vs. 56 (12, p < .01), 63 vs. 57 (24, p < .01), 63 vs. 52 (36, p = .02)). However, when MD with a single risk factor of DM was compared to SD, the difference disappeared. Nine out of 12 (75%) MD + DM had ≥2 risk factors. Conclusions Although long‐term observation of donor kidney function is necessary, careful MD + DM selection had the potential to expand the donor pool.
Collapse
Affiliation(s)
- Kasumi Yoshinaga
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical ScienceOkayama UniversityOkayamaJapan
| | - Motoo Araki
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical ScienceOkayama UniversityOkayamaJapan
| | - Koichiro Wada
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical ScienceOkayama UniversityOkayamaJapan
| | - Takanori Sekito
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical ScienceOkayama UniversityOkayamaJapan
| | - Shogo Watari
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical ScienceOkayama UniversityOkayamaJapan
| | - Yuki Maruyama
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical ScienceOkayama UniversityOkayamaJapan
| | - Yosuke Mitsui
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical ScienceOkayama UniversityOkayamaJapan
| | - Takuya Sadahira
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical ScienceOkayama UniversityOkayamaJapan
| | - Risa Kubota
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical ScienceOkayama UniversityOkayamaJapan
| | - Shingo Nishimura
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical ScienceOkayama UniversityOkayamaJapan
| | - Kohei Edamura
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical ScienceOkayama UniversityOkayamaJapan
| | - Yasuyuki Kobayashi
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical ScienceOkayama UniversityOkayamaJapan
| | - Katsuyuki Tanabe
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Graduate School of Medicine, Dentistry and Pharmaceutical ScienceOkayama UniversityOkayamaJapan
| | - Hidemi Takeuchi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Graduate School of Medicine, Dentistry and Pharmaceutical ScienceOkayama UniversityOkayamaJapan
| | - Masashi Kitagawa
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Graduate School of Medicine, Dentistry and Pharmaceutical ScienceOkayama UniversityOkayamaJapan
| | - Shinji Kitamura
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Graduate School of Medicine, Dentistry and Pharmaceutical ScienceOkayama UniversityOkayamaJapan
| | - Jun Wada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Graduate School of Medicine, Dentistry and Pharmaceutical ScienceOkayama UniversityOkayamaJapan
| | - Masami Watanabe
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical ScienceOkayama UniversityOkayamaJapan
| | - Toyohiko Watanabe
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical ScienceOkayama UniversityOkayamaJapan
| | - Yasutomo Nasu
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical ScienceOkayama UniversityOkayamaJapan
| |
Collapse
|
4
|
[Postoperative complications and long-term outcomes of transplantation with expended criteria donors transplants]. Prog Urol 2020; 30:655-662. [PMID: 32814659 DOI: 10.1016/j.purol.2020.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 04/13/2020] [Accepted: 04/19/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The objective of this study was to analyze early, late complications and outcomes following expended criteria donors (ECD) kidney transplantation compared to standard donors. MATERIALS AND METHODS We performed a retrospective study including 470 patients who received a kidney transplant between 2005 and 2016. Expended criteria donors were defined following the United Network of Organ Sharing criteria. In each group, length of stay, delayed graft function, surgical site infection, acute rejection, surgical complications by type and according to Clavien and Dindo classification were analyzed in univariate and multivariate analysis. The impact of ECD transplant on transplant and patient survival was assessed using a Cox proportional regression model. RESULTS One hundred and ninety seven (41.9%) patients received ECD kidney. The mean follow-up was 61,4 months (22.4-93.89). Patients with ECD transplant presented more delayed graft function (HR=2.1 (1.1-3.68), P=0.008) but the rate of complications including surgical complications was not different. Patients and transplant survival were decreased in ECD transplant group (P=0.005 et 0.001 respectively). In multivariate analysis ECD kidney was an independent factor only associated with decreased transplant survival (HR=1.81 (1.1-2.98), P=0.029) but not with patient survival. CONCLUSION ECD kidney transplantation was not associated with increased postoperative complications but a higher rate of delayed graft function. Nevertheless, it was associated with a decreased transplant survival. The use of pulsatile perfusion machine for explanted criteria transplant should be evaluated to improve these results.
Collapse
|
5
|
Kinoshita Y, Yagisawa T, Sugihara T, Hara K, Takeshima S, Kubo T, Shinzato T, Shimizu T, Suzuki M, Maeshima A, Kamei J, Fujisaki A, Ando S, Suzuki M, Kume H, Fujimura T. Clinical outcomes in donors and recipients of kidney transplantations involving medically complex living donors - a retrospective study. Transpl Int 2020; 33:1417-1423. [PMID: 32654198 DOI: 10.1111/tri.13699] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/14/2020] [Accepted: 07/06/2020] [Indexed: 02/06/2023]
Abstract
We retrospectively compared the post-transplantation graft survival and the donor's estimated glomerular filtration rates (eGFRs) following living donor kidney transplantations (LDKTs) involving medically complex living donors (MCLDs) (the elderly and patients with obesity, hypertension, diabetes mellitus, or reduced renal function) and standard living donors (SLDs). The clinical data on patients who underwent LDKTs at our institution from 2006-2019, including 192 SLDs and 99 MCLDs, were evaluated. Regarding recipients, the log-rank test and multivariable Cox proportional hazards analyses showed a higher incidence of overall and death-censored graft loss in the recipients who received kidneys from MCLDs (Hazard ratio = 2.16 and 3.25, P = 0.015 and 0.004, respectively), after adjusting for recipient-related variables including age, sex, duration of dialysis, ABO compatibility, and donor-specific antibody positivity. Regarding donors, a linear mixed model showed significantly lower postdonation eGFRs (-2.25 ml/min/1.73 m2 , P = 0.048) at baseline in MCLDs than SLDs, but comparable change (difference = 0.01 ml/min/1.73 m2 /year, P = 0.97). In conclusion, although kidneys from MCLDs are associated with impaired graft survival, the donation did not adversely affect the MCLDs' renal health in at least the short-term. LDKTs involving carefully selected MCLDs would be an acceptable alternative for recipients with no SLDs.
Collapse
Affiliation(s)
- Yoshitaka Kinoshita
- Division of Renal Surgery and Transplantation, Department of Urology, Jichi Medical University, Tochigi, Japan.,Division of Urology, Department of Urology, Jichi Medical University, Tochigi, Japan
| | - Takashi Yagisawa
- Division of Renal Surgery and Transplantation, Department of Urology, Jichi Medical University, Tochigi, Japan
| | - Toru Sugihara
- Division of Urology, Department of Urology, Jichi Medical University, Tochigi, Japan
| | - Konan Hara
- Department of Public Health, The University of Tokyo, Tokyo, Japan
| | - Saki Takeshima
- Division of Renal Surgery and Transplantation, Department of Urology, Jichi Medical University, Tochigi, Japan
| | - Taro Kubo
- Division of Renal Surgery and Transplantation, Department of Urology, Jichi Medical University, Tochigi, Japan
| | - Takahiro Shinzato
- Division of Renal Surgery and Transplantation, Department of Urology, Jichi Medical University, Tochigi, Japan
| | - Toshihiro Shimizu
- Division of Renal Surgery and Transplantation, Department of Urology, Jichi Medical University, Tochigi, Japan
| | - Michiko Suzuki
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Akito Maeshima
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Jun Kamei
- Division of Urology, Department of Urology, Jichi Medical University, Tochigi, Japan
| | - Akira Fujisaki
- Division of Urology, Department of Urology, Jichi Medical University, Tochigi, Japan
| | - Satoshi Ando
- Division of Urology, Department of Urology, Jichi Medical University, Tochigi, Japan
| | - Motofumi Suzuki
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tetsuya Fujimura
- Division of Urology, Department of Urology, Jichi Medical University, Tochigi, Japan
| |
Collapse
|
6
|
Hamano I, Hatakeyama S, Fujita T, Murakami R, Hamaya T, Togashi K, Suzuki Y, Yamamoto H, Yoneyama T, Yoneyama T, Hashimoto Y, Narumi S, Tomita H, Ohyama C. Living Kidney Transplantation From Marginal Donors Presents Feasible Donor Renal Function Despite Inferior Recipient Renal Function. Transplant Proc 2020; 52:1723-1728. [DOI: 10.1016/j.transproceed.2020.01.157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 01/22/2020] [Indexed: 02/07/2023]
|
7
|
Boissier R, François P, Gondran Tellier B, Meunier M, Lyonnet L, Simoncini S, Magalon J, Legris T, Arnaud L, Giraudo L, Dignat George F, Karsenty G, Burtey S, Lechevallier E, Sabatier F, Paul P. Perirenal Adipose Tissue Displays an Age-Dependent Inflammatory Signature Associated With Early Graft Dysfunction of Marginal Kidney Transplants. Front Immunol 2020; 11:445. [PMID: 32256495 PMCID: PMC7089962 DOI: 10.3389/fimmu.2020.00445] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 02/26/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Better understanding of the contribution of donor aging and comorbidity factors of expanded criteria donors (ECD) to the clinical outcome of a transplant is a challenge in kidney transplantation. We investigated whether the features of donor-derived stromal vascular fraction of perirenal adipose tissue (PRAT-SVF) could be indicative of the deleterious impact of the ECD microenvironment on a renal transplant. Methods: A comparative analysis of cellular components, transcriptomic and vasculogenic profiles was performed in PRAT-SVF obtained from 22 optimal donors and 31 ECD deceased donors. We then investigated whether these parameters could be associated with donor aging and early allograft dysfunction. Results: When compared with the PRAT-SVF of non-ECD donors, ECD PRAT-SVF displayed a lower proportion of stromal cells, a higher proportion of inflammatory NK cells. The global RNA sequencing approach indicated a differential molecular signature in the PRAT-SVF of ECD donors characterized by the over-expression of CXCL1 and IL1-β inflammatory transcripts. The vasculogenic activity of PRAT-SVF was highly variable but was not significantly affected in marginal donors. Periorgan recruitment of monocytes/macrophages and NK cells in PRAT-SVF was associated with donor aging. The presence of NK cell infiltrates was associated with lower PRAT-SVF angiogenic activity and with early allograft dysfunction evaluated on day 7 and at 1 month post-transplant. Conclusions: Our results indicate that human NK cell subsets are differentially recruited in the periorgan environment of aging kidney transplants. We provide novel evidence that PRAT-SVF represents a non-invasive and timely source of donor material with potential value to assess inflammatory features that impact organ quality and function.
Collapse
Affiliation(s)
- Romain Boissier
- Department of Urology and Renal Transplantation, La Conception University Hospital, Assistance Publique-Hôpitaux Marseille (APHM), Aix-Marseille Univ., Marseille, France.,C2VN, INSERM 1263, Aix-Marseille Univ, INRAE, Marseille, France
| | - Pauline François
- C2VN, INSERM 1263, Aix-Marseille Univ, INRAE, Marseille, France.,Cell Therapy Department, La Conception University Hospital APHM, Aix-Marseille Univ., INSERM CIC 1409, Marseille, France
| | - Bastien Gondran Tellier
- Department of Urology and Renal Transplantation, La Conception University Hospital, Assistance Publique-Hôpitaux Marseille (APHM), Aix-Marseille Univ., Marseille, France.,C2VN, INSERM 1263, Aix-Marseille Univ, INRAE, Marseille, France
| | - Maité Meunier
- Department of Nephrology and Renal Transplantation, La Conception University Hospital, Assistance Publique-Hôpitaux Marseille (APHM), Aix-Marseille Univ., Marseille, France
| | - Luc Lyonnet
- Department of Hematology and Vascular biology, La Conception University Hospital, Assistance Publique-Hôpitaux Marseille (APHM), Aix Marseille Univ., Marseille, France
| | | | - Jeremy Magalon
- C2VN, INSERM 1263, Aix-Marseille Univ, INRAE, Marseille, France.,Cell Therapy Department, La Conception University Hospital APHM, Aix-Marseille Univ., INSERM CIC 1409, Marseille, France
| | - Tristan Legris
- Department of Nephrology and Renal Transplantation, La Conception University Hospital, Assistance Publique-Hôpitaux Marseille (APHM), Aix-Marseille Univ., Marseille, France
| | - Laurent Arnaud
- Department of Hematology and Vascular biology, La Conception University Hospital, Assistance Publique-Hôpitaux Marseille (APHM), Aix Marseille Univ., Marseille, France
| | - Laurent Giraudo
- Cell Therapy Department, La Conception University Hospital APHM, Aix-Marseille Univ., INSERM CIC 1409, Marseille, France
| | - Françoise Dignat George
- C2VN, INSERM 1263, Aix-Marseille Univ, INRAE, Marseille, France.,Department of Hematology and Vascular biology, La Conception University Hospital, Assistance Publique-Hôpitaux Marseille (APHM), Aix Marseille Univ., Marseille, France
| | - Gilles Karsenty
- Department of Urology and Renal Transplantation, La Conception University Hospital, Assistance Publique-Hôpitaux Marseille (APHM), Aix-Marseille Univ., Marseille, France
| | - Stéphane Burtey
- C2VN, INSERM 1263, Aix-Marseille Univ, INRAE, Marseille, France.,Department of Nephrology and Renal Transplantation, La Conception University Hospital, Assistance Publique-Hôpitaux Marseille (APHM), Aix-Marseille Univ., Marseille, France
| | - Eric Lechevallier
- Department of Urology and Renal Transplantation, La Conception University Hospital, Assistance Publique-Hôpitaux Marseille (APHM), Aix-Marseille Univ., Marseille, France
| | - Florence Sabatier
- C2VN, INSERM 1263, Aix-Marseille Univ, INRAE, Marseille, France.,Cell Therapy Department, La Conception University Hospital APHM, Aix-Marseille Univ., INSERM CIC 1409, Marseille, France
| | - Pascale Paul
- C2VN, INSERM 1263, Aix-Marseille Univ, INRAE, Marseille, France.,Department of Hematology and Vascular biology, La Conception University Hospital, Assistance Publique-Hôpitaux Marseille (APHM), Aix Marseille Univ., Marseille, France
| |
Collapse
|
8
|
Cell-free MicroRNA miR-505-3p in Graft Preservation Fluid Is an Independent Predictor of Delayed Graft Function After Kidney Transplantation. Transplantation 2019; 103:329-335. [PMID: 30444806 DOI: 10.1097/tp.0000000000002527] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Delayed graft function (DGF), a common complication after transplantation of deceased donor kidneys, affects both short- and long-term outcomes. Currently available biomarkers during graft preservation lack sensitivity in predicting risk for DGF. The aim of this study is to identify cell-free micro ribonucleic acid (miRNA) biomarkers in graft preservation fluid predictive of DGF after kidney transplantation. METHODS Vascular bed preservation fluid was collected from 48 kidney grafts from donation after circulatory death (DCD) or donation after brain death (DBD) donors. miRNA profiles were determined by polymerase chain reaction (PCR) array (n = 8) and validated by reverse transcription and quantitative PCR (n = 40). Graft function posttransplantation was defined as immediate good function (IF) or DGF. RESULTS A total of 223 miRNAs fulfilled the preset parameters (Ct < 40 in 3 or more samples) and were included in the analysis. Thirty-two miRNAs were significantly different between DGF and IF kidney grafts (P < 0.05) but, after correction for multiple testing, only miR-505-3p remained significant. The significant association of high miR-505-3p levels with DGF was confirmed in an independent validation cohort using conventional reverse transcription and quantitative PCR detection. Multivariate analyses showed miR-505-3p as an independent predictor for DGF (odds ratio, 1.12; P = 0.028). If stratified for donor type, miR-505-3p levels remained significantly different between IF and DGF in DCD grafts (P < 0.01), but not in DBD grafts. Receiver operating characteristic curve analysis showed a high sensitivity and specificity (area under the curve, 0.833). CONCLUSIONS In DCD grafts, high levels of miR-505-3p in preservation fluid are associated with increased risk of DGF after kidney transplantation. Further study is required to confirm the utility of cell-free miR-505-3p as prognostic biomarker for DGF.
Collapse
|
9
|
Pereira LDNG, Nogueira PCK. Non-standard criteria donors in pediatric kidney transplantation. Pediatr Transplant 2019; 23:e13452. [PMID: 31066489 DOI: 10.1111/petr.13452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/20/2019] [Accepted: 03/22/2019] [Indexed: 12/21/2022]
Abstract
KT remains the treatment of choice for ESRD in children. However, the demand for kidney transplants continues to outstrip supply, even in the pediatric scenario. We reviewed the applicability of nonSCDs for pediatric KT. There is a lack of studies analyzing this modality among pediatric donors and recipients, where most conclusions are based on predictions from adult data. Nevertheless, marginal donors might be a reasonable option in selected cases. For example, the use of older LDs is an acceptable option, with outcomes comparable to SCDs. Organs donated after cardiac death represent another possibility, albeit with logistic, ethical, and legal limitations in some countries. AKI donors also constitute an option in special situations, although there are no pediatric data on these transplants. Likewise, there are no data on the use of expanded criteria donors in pediatric patients, but this appears not to be a good option, considering the compromised long-term survival.
Collapse
Affiliation(s)
| | - Paulo Cesar Koch Nogueira
- Pediatric Nephrology Division, Pediatric Department, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| |
Collapse
|
10
|
Zahran MH, Kamal AI, Abdelfattah A, Mashaly ME, Fakhreldin I, Osman Y, Ali-El-Dein B. Outcome of Live-Donor Renal Transplants With Incidentally Diagnosed Renal Angiomyolipoma in the Donor. Transplant Proc 2019; 51:1773-1778. [PMID: 31255355 DOI: 10.1016/j.transproceed.2019.02.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 02/18/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Accepting donors with renal lesion amenable for pre-transplant management with no suspected long-term harm seems to expand the live-donor pool. We aimed to assess the long-term outcome of live-donor renal transplantation with incidentally discovered renal angiomyolipoma (AML) during routine evaluation of donors. PATIENTS AND METHODS A retrospective evaluation of incidentally discovered AML, during live-related-donor evaluation, was performed. The tumor criteria were retrieved. In cases with exophytic tumor, a back-table, partial nephrectomy was done with frozen section to exclude malignancy. Endophytic lesions were kept in situ and transplanted. Both donor and recipient were followed up by periodic imaging. RESULTS Among 2925 cases, 6 AML with a median volume of 0.96 (range, 0.5-2) cm2 were identified. The median recipients' age was 21 (range, 10-38) years and the median donors' age was 48 (range, 45-50). Two AML were exophytic and back-table partial nephrectomy was performed, while 4 were endophytic and kept in situ, and the kidney was transplanted. After a median follow-up of 82 (range, 25-150) months, 4 patients were alive with functioning grafts and 2 resumed hemodialysis 5 and 7 years after transplantation. There was no evidence of increase in the AML size or newly developed AML in the grafts. All donors were alive with normal renal function (mean ± standard deviation, serum creatinine was 0.9 ± 0.2 mg/dL) and none developed new AML in the remaining kidney. CONCLUSION Incidentally discovered AML during live-donor evaluation is not a contraindication of donation after proper counseling of the couples and regular, periodic follow-up.
Collapse
Affiliation(s)
- Mohamed H Zahran
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
| | - Ahmed I Kamal
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | | | | | - Islam Fakhreldin
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Yasser Osman
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | | |
Collapse
|
11
|
Xiong J, Su T, Zhu P, Ao Q, Ruan Q, Wang G. Malignant rhabdoid tumor in the renal allograft of an adult transplant recipient: a unique case of a rare tumor. Diagn Pathol 2017; 12:86. [PMID: 29258531 PMCID: PMC5738181 DOI: 10.1186/s13000-017-0677-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 12/08/2017] [Indexed: 11/10/2022] Open
Abstract
Background Renal transplant recipients have increased risk for developing malignant diseases because of immunosuppression or donor-to-recipient transmission. Malignant rhabdoid tumor (MRT) is a rare, highly aggressive and lethal tumor primarily affecting the kidney of infants and young children. MRT has not been reported in the renal allograft of an adult recipient after kidney transplantation. Case presentation In this report, a 47-year-old woman who received a kidney transplantation from an infant donor and developed a mass in the transplanted kidney is presented. Pathological examinations revealed a malignant tumor with rhabdoid cells morphologically and the loss of INI1 expression immunohistochemically. The diagnosis of malignant rhabdoid tumor in the transplanted kidney was made. We confirmed that donor-to-recipient malignancy transmission was the cause of MRT in the transplanted kidney by fluorescence in situ hybridization (FISH) and short tandem repeat (STR) analysis. Conclusion To our knowledge, this is the first case of MRT in an adult renal allograft recipient. This report highlights the importance of the criteria for selection of donors to screen possible malignant tumors transmission.
Collapse
Affiliation(s)
- Jing Xiong
- Institute of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, People's Republic of China
| | - Tiefen Su
- Institute of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, People's Republic of China.,Department of Pathology, School of Basic Medical Science, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Pengcheng Zhu
- Institute of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, People's Republic of China. .,Department of Pathology, School of Basic Medical Science, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.
| | - Qilin Ao
- Institute of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, People's Republic of China.,Department of Pathology, School of Basic Medical Science, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Qiurong Ruan
- Institute of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, People's Republic of China.,Department of Pathology, School of Basic Medical Science, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Guoping Wang
- Institute of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, People's Republic of China.,Department of Pathology, School of Basic Medical Science, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| |
Collapse
|
12
|
Hassan EA, Ali TZ, Abdulbaki A, Ibrahim IA, Almanae HM, Aleid HA. Histopathologic Findings of Potential Kidney Donors With Asymptomatic Microscopic Hematuria: Impact on Donation. Transplant Proc 2017; 49:1729-1732. [PMID: 28923616 DOI: 10.1016/j.transproceed.2017.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 05/13/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Isolated microscopic hematuria (IMH) is not uncommon in potential kidney donors. AIM The aim was to study the kidney biopsy findings of potential kidney donors with IMH and the impact of the histopathologic diagnoses on the decision to accept or decline such donors from kidney donation. METHODS In this retrospective study, all the potential kidney donors with IMH were identified from the medical records of patients who underwent kidney biopsies between January 2010 and December 2016. RESULTS Forty-five such individuals were identified. The mean age of these potential donors was 32.6 years and 76% were male. All of them had normal blood pressure and no significant proteinuria. Seventeen (38%) biopsies showed histopathologic abnormalities; thin basement membrane disease (n = 13; 28%) was the most common cause followed by immunoglobulin (Ig)A nephropathy (n = 4; 9%). Donors with abnormal biopsy findings were excluded from donation. However, 62% of the potential donors had normal kidney biopsy findings and were accepted for kidney donation. CONCLUSION IMH justifies extensive work-up including kidney biopsy to identify donors who may have underlying significant glomerular pathology excluding them from kidney donation. On the other hand, kidney biopsy also helps in accepting the donors if it does not show significant abnormality.
Collapse
Affiliation(s)
- E A Hassan
- Adult Transplant Nephrology, Department of Kidney & Pancreas Transplantation, King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia; Department of Nephrology, Fayoum University, Fayoum, Egypt.
| | - T Z Ali
- Adult Transplant Nephrology, Department of Kidney & Pancreas Transplantation, King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - A Abdulbaki
- Adult Transplant Nephrology, Department of Kidney & Pancreas Transplantation, King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - I A Ibrahim
- Adult Transplant Nephrology, Department of Kidney & Pancreas Transplantation, King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia; Department of Nephrology, Cairo University, Cairo, Egypt
| | - H M Almanae
- Department of Pathology & Laboratory Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - H A Aleid
- Adult Transplant Nephrology, Department of Kidney & Pancreas Transplantation, King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia
| |
Collapse
|
13
|
Abstract
Organ transplantation is an ideal treatment for certain late-stage diseases. With the report of a penile transplantation in Tygerberg Hospital, South Africa, this topic has, once again, aroused exploration in the field. At present, two penile transplantation operations have been performed and gained some positive results. Patients can gain void standing, erectile function and better cosmetic appearance. However, debates and potential risks still exist. Here, we briefly review the progress of studies in this filed and discusses the potential risks and debates in penile transplantation.
Collapse
Affiliation(s)
- Jinhong Li
- Jinhong Li, MD. Andrology Laboratory/Dept. of Urology, Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, 610000, China
| | - Feng Qin
- Feng Qin, MD. Andrology Laboratory, Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, 610000, China
| | - Ping Han
- Ping Han, MD. Dept. of Urology, Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, 610000, China
| | - Jiuhong Yuan
- Jiuhong Yuan, MD. Andrology Laboratory/Dept. of Urology, Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, 610000, China
| |
Collapse
|
14
|
Ayar Y, Ersoy A, Ocakoglu G, Yildiz A, Oruc A, Soyak H, Calapkulu M, Sahin A, Topal NB, Okeer E, Coskun B, Kaygisiz O, Kordan Y, Vuruskan H. Risk Factors Affecting Graft and Patient Survivals After Transplantation From Deceased Donors in a Developing Country: A Single-Center Experience. Transplant Proc 2017; 49:270-277. [DOI: 10.1016/j.transproceed.2016.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 11/18/2016] [Accepted: 12/13/2016] [Indexed: 12/27/2022]
|
15
|
Graziano V, Buccelli C, Capasso E, De Micco F, Casella C, Di Lorenzo P, Paternoster M. Suggestions on how to make suboptimal kidney transplantation an ethically viable option. Open Med (Wars) 2016; 11:523-529. [PMID: 28352845 PMCID: PMC5329877 DOI: 10.1515/med-2016-0090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 10/31/2016] [Indexed: 01/10/2023] Open
Abstract
To overcome kidney donation, the pool of potentially eligible donors has been widened by using suboptimal organs harvested from living donors or cadavers. These organs may engender health complications as age, risk factors, and pathologies of donors fail to meet the standard donor criteria. After examining a wide array of literature on suboptimal kidney transplants, we evidenced two major issues: the lack of standardized terminology and the lack of longterm data on the health outcomes of both suboptimal living donors and recipients. Consequently, surgeons are still unable to provide patients with thorough information to obtain a well-informed consent. Suboptimal kidney transplantation still remains in its experimental stage, thereby raising many ethical and medico-legal concerns. We suggest that one possible solution to overcome some of the ethical shortcomings of suboptimal kidney donations is to provide living donors and recipients honest, accurate, and thorough information about its health risks. To this aim, we advocate adopting a widely standardized terminology that would embrace the whole concept of suboptimal kidney transplantation, increasing the number of future publications on the health outcomes of living donors and recipients, spurring ethical reflection to improve the experience of suboptimal kidney transplantation and reduce the waiting-list for kidney transplantation.
Collapse
Affiliation(s)
- Vincenzo Graziano
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”. Via S. Pansini 5, 80131, Naples, Italy
| | - Claudio Buccelli
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”. Via S. Pansini 5, 80131, Naples, Italy
| | - Emanuele Capasso
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”. Via S. Pansini 5, 80131, Naples, Italy
| | - Francesco De Micco
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”. Via S. Pansini 5, 80131, Naples, Italy
| | - Claudia Casella
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”. Via S. Pansini 5, 80131, Naples, Italy
| | - Pierpaolo Di Lorenzo
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”. Via S. Pansini 5, 80131, Naples, Italy
| | - Mariano Paternoster
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”. Via S. Pansini 5, 80131, Naples, Italy
| |
Collapse
|
16
|
Crawford K, Low JK, Manias E, Williams A. Healthcare professionals can assist patients with managing post-kidney transplant expectations. Res Social Adm Pharm 2016; 13:1204-1207. [PMID: 27955977 DOI: 10.1016/j.sapharm.2016.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 11/29/2016] [Indexed: 12/11/2022]
Abstract
Kidney transplantation is the preferred treatment option for end-stage kidney disease. However, transplantation is not a cure and the prospective recipient needs to carefully evaluate the risks and benefits of receiving a transplant before agreeing to have the transplant. The objective of this commentary is to demonstrate that many kidney transplant recipients have unrealistic expectations of what life after transplantation involves. After monitoring participants in a randomised controlled trial through the first 12 months post-transplantation, we question whether patients understood the impact of receiving a transplant. In our study, participants were not prepared for the considerable time and effort involved in adhering to their medications. Participants felt challenged by the constant hospital, pathology and pharmacy visits; they were fearful that their transplant could reject; and they struggled with adapting to their new way of living. This paper offers new insights into understanding the life of patients post transplantation and the challenges of informing patients about the consequences of kidney transplantation. Understanding the challenges faced by new transplant recipients can help health professionals educate patients about life post-transplantation so patients have a genuine understanding of what they are consenting to, which is likely to enhance medication adherence and ultimately, graft success.
Collapse
Affiliation(s)
- Kimberley Crawford
- Faculty of Medicine, Nursing and Health Sciences, School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia.
| | - Jac Kee Low
- Faculty of Medicine, Nursing and Health Sciences, School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Melbourne, Victoria, Australia; The Royal Melbourne Hospital, Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia; Melbourne School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Allison Williams
- Faculty of Medicine, Nursing and Health Sciences, School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
17
|
McGregor TB, Rampersad C, Patel P. Expanding living kidney donor criteria with ex-vivo surgery for renal anomalies. Can Urol Assoc J 2016; 10:301-305. [PMID: 27800047 DOI: 10.5489/cuaj.3841] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Renal transplantation remains the gold standard treatment for end-stage renal disease, with living donor kidneys providing the best outcomes in terms of allograft survival. As the number of patients on the waitlist continues to grow, solutions to expand the donor pool are ongoing. A paradigm shift in the eligibility of donors with renal anomalies has been looked at as a potential source to expand the living donor pool. We sought to determine how many patients presented with anatomic renal anomalies at our transplant centre and describe the ex-vivo surgical techniques used to render these kidneys suitable for transplantation. METHODS A retrospective review was performed of all patients referred for surgical suitability to undergo laparoscopic donor nephrectomy between January 2011 and January 2015. Patient charts were analyzed for demographic information, perioperative variables, urological histories, and postoperative outcomes. RESULTS 96 referrals were identified, of which 81 patients underwent laparoscopic donor nephrectomy. Of these patients, 11 (13.6%) were identified as having a renal anomaly that could potentially exclude them from the donation process. These anomalies included five patients with unilateral nephrolithiasis, four patients with large renal cysts (>4 cm diameter), one patient with an angiomyolipoma (AML) and one patient with a calyceal diverticulum filled with stones. A description of the ex-vivo surgical techniques used to correct these renal anomalies is provided. CONCLUSIONS We have shown here that ex-vivo surgical techniques can safely and effectively help correct some of these renal anomalies to render these kidneys transplantable, helping to expand the living donor pool.
Collapse
Affiliation(s)
| | | | - Premal Patel
- Section of Urology; University of Manitoba, Winnipeg, MB, Canada
| |
Collapse
|
18
|
Mesenchymal Stem Cell-Based Therapy for Kidney Disease: A Review of Clinical Evidence. Stem Cells Int 2016; 2016:4798639. [PMID: 27721835 PMCID: PMC5046016 DOI: 10.1155/2016/4798639] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 07/15/2016] [Accepted: 08/18/2016] [Indexed: 12/15/2022] Open
Abstract
Mesenchymal stem cells form a population of self-renewing, multipotent cells that can be isolated from several tissues. Multiple preclinical studies have demonstrated that the administration of exogenous MSC could prevent renal injury and could promote renal recovery through a series of complex mechanisms, in particular via immunomodulation of the immune system and release of paracrine factors and microvesicles. Due to their therapeutic potentials, MSC are being evaluated as a possible player in treatment of human kidney disease, and an increasing number of clinical trials to assess the safety, feasibility, and efficacy of MSC-based therapy in various kidney diseases have been proposed. In the present review, we will summarize the current knowledge on MSC infusion to treat acute kidney injury, chronic kidney disease, diabetic nephropathy, focal segmental glomerulosclerosis, systemic lupus erythematosus, and kidney transplantation. The data obtained from these clinical trials will provide further insight into safety, feasibility, and efficacy of MSC-based therapy in renal pathologies and allow the design of consensus protocol for clinical purpose.
Collapse
|
19
|
|
20
|
Defortescu G, Nouhaud FX, Cornu JN, Pfister C. RE: Marginal Donors in Renal Transplantation. Transplant Proc 2015; 47:2081-2. [PMID: 26293106 DOI: 10.1016/j.transproceed.2015.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Guillaume Defortescu
- Department of Urology and Renal Transplantation, Rouen University Hospital, France
| | | | - Jean-Nicolas Cornu
- Department of Urology and Renal Transplantation, Rouen University Hospital, France
| | - Christian Pfister
- Department of Urology and Renal Transplantation, Rouen University Hospital, France.
| |
Collapse
|