Living or deceased-donor kidney transplant: the role of psycho-socioeconomic factors and outcomes associated with each type of transplant

BACKGROUND

Kidney transplant improves patients' survival and quality of life. Worldwide, concern about the equality of access to the renal transplant wait-list is increasing. In Iran, patients have the choice to be placed on either the living or deceased-donor transplant wait-list.

METHODS

This was a prospective study performed on 416 kidney transplant recipients (n = 217 (52.2%) from living donors and n = 199 (47.8%) from deceased donors). Subjects were recruited from four referral kidney transplant centers across Tehran, Iran, during 2016-2017. The primary outcome was to identify the psycho-socioeconomic factors influencing the selection of type of donor (living versus deceased). Secondary objective was to compare the outcomes associated with each type of transplant. The impact of psycho-socioeconomic variables on selecting type of donor was evaluated by using multiple logistic regression and the effect of surgical and non-surgical variables on the early post-transplant creatinine trend was assessed by univariate repeated measure ANOVA.

RESULTS

Based on standardized coefficients, the main predictors for selecting living donor were academic educational level (adjusted OR = 3.25, 95% CI: 1.176-9.005, p = 0.023), psychological status based on general health questionnaire (GHQ) (adjusted OR = 2.46, 95% CI: 1.105-5.489, p = 0.028), and lower monthly income (adjusted OR = 2.20, 95% CI: 1.242-3.916, p = 0.007). The waiting time was substantially shorter in patients who received kidneys from living donors (p < 0.001). The early post-transplant creatinine trend was more desirable in recipients of living donors (β = 0.80, 95% CI: 0.16-1.44, p-value = 0.014), patients with an ICU stay of fewer than five days (β = - 0.583, 95% CI: - 0.643- -0.522, p-value = < 0.001), and those with less dialysis duration time (β = 0.016, 95% CI: 0.004-0.028, p-value = 0.012). Post-operative surgical outcomes were not different across the two groups of recipients (p = 0.08), however, medical complications occurred considerably less in the living-donor group (p = 0.04).

CONCLUSION

Kidney transplant from living donors was associated with shorter transplant wait-list period and better early outcome, however, inequality of access to living donors was observed. Patients with higher socioeconomic status and higher level of education and those suffering from anxiety and sleep disorders were significantly more likely to select living donors.

Long-term outcome of trans urethral prostatectomy in benign prostatic hyperplasia patients with and without diabetes mellitus

OBJECTIVE

To compare the different aspects of the postoperative outcomes in diabetics and nondiabetics of transurethral prostatectomy in patients with benign prostatic hyperplasia.

METHODS

From December 2000 to December 2003, a total of 138 men with BPH, who were candidates for transurethral resection of the prostate (TURP), were selected for this study, of these 20 were diabetics. The International Prostate Symptom Score (I-PSS) and the erectile function were assessed preoperatively and during an average follow-up period of 63 months postoperatively. Comorbid conditions and all surgical complications during the follow-up were recorded.

RESULTS

No significant differences were detected between the baseline IPSS and the prostate volume in diabetic and nondiabetic patients. Both groups showed significant reductions in IPSS, and greater reductions were detected in nondiabetic patients 6 months after their operations that were not statistically significant (23.5 +/- 8.0 versus 20.9 +/- 7.6 respectively, p = 0.169). There were no significant differences in the perioperative complications. The incidence of a second TURP was higher in diabetics (25% vs. 7.8%, p = 0.033). Although not statistically significant, a higher incidence of postoperative erectile dysfunction (ED) in diabetic patients (37.5% vs. 11.5%, p = 0.073) was observed.

CONCLUSION

TURP is a beneficial and safe procedure in diabetic patients with BPH and is not associated with a higher incidence of perioperative or postoperative complications except for the possible postoperative ED and the retreatment rate that seems to be higher.

Erectile dysfunction after prostatectomy: an evaluation of the risk factors

OBJECTIVE

The occurrence of erectile dysfunction (ED) in patients who have undergone prostatectomy has been assessed in the previous studies; however, its rate and risk factors vary in different studies. This study was conducted to assess the possible risk factors for ED after prostatectomy.

MATERIAL AND METHODS

In total, 246 men with benign prostatic hyperplasia (BPH) who were candidates for either open prostatectomy or transurethral resection of the prostate (TURP) were admitted in this study during a period of 3 years between December 2000 and December 2003. Cardiac risk index was assessed before the operation using American Heart Association guidelines and erectile function was assessed both preoperatively and 6 months after surgery. Patients with moderate to severe ED according to the five-item version of the International Index of Erectile Function were considered as ED afflicted. In this study, the prevalence of preoperative ED, the incidence of postoperative ED, and those conditions that could lead to an increase in the incidence of postoperative ED in either procedure were determined.

RESULTS

The mean age of the patients was 63.7+/-9.7 years. The prevalence rates of preoperative ED were 24.6% and 25.9% in TURP and open prostatectomy groups, respectively. Among patients with no or mild ED preoperatively, 12.5% showed moderate to severe ED postoperatively (13.4% in TURP group vs 11.25% in open prostatectomy group).

CONCLUSIONS

The incidence rate of postoperative ED after prostatectomy was 12.5%. Risk factors for its appearance included hypertension, diabetes mellitus, higher transfusion rates, higher cardiac risk index and an older age.

Donor nephrectomy with and without preservation of gonadal vein while dissecting the ureter

INTRODUCTION

Preservation of the gonadal vein while dissecting the ureter for donor nephrectomy may decrease the distal ureteral ischemia and urological complications in kidney transplant recipients. In this study, we compared the outcome of kidney allografts harvested with preservation of the gonadal vein while dissecting the ureter with allografts harvested without preserving the gonadal vein.

MATERIALS AND METHODS

We reviewed 167 consecutive kidney transplantations between April 2003 and April 2004. During donor nephrectomy, we preserved the gonadal vein in 106 harvested kidneys (group 1), while we did not preserve this vein in 61 allografts (group 2). The recipients in each group were followed up for a 2-year follow-up on average, and the outcomes including ureteral complications, graft loss, and patient and graft survival were compared between the two groups.

RESULTS

Urine leakage was noted in few patients (2 in group 1 and 3 in group 2) and its frequency was not significantly different between the two groups (P = .26). Ureteral stricture was not seen in any of the kidney allograft recipients. No differences were found in the frequencies of acute rejection episodes, graft loss, and death between the two groups.

CONCLUSION

Preservation of the gonadal veins did not significantly decrease the frequency of ureteral complications in the kidney transplant recipients. We recommend meticulous handling of the ureter in donor nephrectomies to prevent further remote complications regardless of the approach to the gonadal veins while nephrectomy.