Kidney transplantation (original) (raw)
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The evolution of renal transplantation in clinical practice: for better, for worse?
QJM : monthly journal of the Association of Physicians, 2008
Kidney transplantation is the optimal form of renal replacement therapy for most patients with end-stage renal disease. Attempting to improve graft and recipient survival remains challenging in clinical practice. To identify the factors that have significantly changed over the past four decades and assess their impact on renal transplant outcomes. Retrospective review of all renal transplant procedures in a single UK region. All 1346 renal transplant procedures performed between 1 January 1967 and 31 December 2006 were reviewed. Clinical data, histological reports and outcomes were available from a prospectively recorded database. The study period was divided into four decades to assess the changes in renal transplantation over time. Significant changes that have occurred include an increase in donor and recipient ages, a greater proportion of recipients with diabetic nephropathy, a longer wait before the first transplant procedure, a fall in the incidence and impact of acute reject...
Trends in Kidney Transplantation over the Past Decade
Drugs, 2008
potential for increased longevity and enhanced quality of life; however, the demand for kidneys far exceeds the available supply. This has led to an increase in the number of people on waiting lists and an increase in waiting time. In the US, the overall median wait time was 2.85 years in 2004. The projected median waiting time for adult patients awaiting a deceased donor kidney in 2006 is 4.58 years. The renal transplant community has pursued multiple avenues in an attempt to increase the donor pool, but this remains a major challenge. In the last decade, the number of live donor kidney transplants performed in the US and Canada has doubled and represents just over 40% of all donor kidneys. Among deceased donor kidneys, the largest percentage increases were seen in expanded criteria donor and donation after cardiac death kidneys. In the last decade, the age distribution among donors, and among patients on waiting lists or receiving a renal transplant, has shifted towards older age groups. There have been dramatic shifts in baseline immunosuppression with increased usage of induction agents and the nearly universal replacement of azathioprine by mycophenolate. Additionally, tacrolimus use has increased from 13% to 79% at discharge, while ciclosporin (cyclosporine) use has fallen from 76% to 15%. Although 1-year graft survival rates are excellent, only modest improvements have been observed in long-term graft survival rates in the last decade. Thus, efforts have shifted from improving early graft outcomes to altering the natural course of late graft failure. Death of transplant recipients from cardiovascular disease, infection and cancer remains an important limitation in kidney transplantation. Continued success in kidney transplantation will require increased numbers of donors, both living and deceased, as well as reduction in the primary causes of late transplant loss, namely premature patient death with a functioning graft and chronic allograft nephropathy.
Renal Transplantation: Progress and Prospects
Artificial Organs, 1996
Abstract: Despite encouraging and improving results, organ transplantation is still hampered by a shortage of organs, chronic transplant loss, and a changed patient population. Liberal inclusion criteria for dialysis and/or renal transplantation and the increasing unwillingness to donate organs in some countries has led to a growing imbalance between the numbers of transplantations performed and patients on waiting lists. Until now, poorly understood chronic transplant dysfunction is responsible for a still unchanged graft loss of approximately 5% per year. The patient population has changed to include more multimorbidity and an increasing number of risk factors (age, diabetes mellitus, former [failed] transplantations, or preexisting cardiovascular diseases). The recommendation for or against dialysis or transplantation has become increasingly difficult for the responsible physician. Newly developed immunosuppressant drugs, an increasing consideration regarding living organ donation, or xenotransplantation in the future may solve this dilemma. New reflections and considerations about the ethical background of transplantation medicine are necessary.
Renal transplantation — An experience of 500 patients
Medical Journal Armed Forces India, 2007
Background: Renal transplantation is the treatment modality of choice for patients with end stage kidney failure. We present our experience of graft and patient survival of initial 500 renal transplants performed between May 1991 and July 2006, at Army Hospital (R&R). Material and Methods: All patients received triple drug immunosuppression with cyclosporine/tacrolimus, azathioprine/ mycophenolate mofetil and steroids. Patients in high risk group received induction therapy with IL-2 receptor blockers/antithymocyte globulin. Results: Majority of the recipients (79%) were males, whereas majority of the donors (59.4%) were females. In the donor profile, 385 (77%) transplants were live related, 108 (21.6 %) were spousal and 7 (1.4%) were cadaveric transplants. Mean age of the donors and recipients was 42.11 ± 11.53 years (range 19-72 years) and 33 ± 9.39 years (range 5-60 years) respectively. Eighty two patients (16.4%) were lost to follow up and the present data on rejections, patients and graft survival pertains to 418 patients. These patients have been followed up for a mean period of 2.63 years (SE, 0.122; median 1.8 years; range 0-13.36 years). Acute rejection episodes occurred in 115 (27.3%) patients and 95% of these could be reversed with steroids/ATG. Sixty eight patients (16%) have died on follow-up. Our one-year, 5 year and 10 year estimated graft survival is 95.4% (SE, 0.01), 80.5% (SE, 0.03) and 53.1% (SE, 0.09) respectively and patient survival at one year is 93.2% (SE, 0.01). The estimated graft and patient survival in our series is 9.83 (95% CI, 8.92-10.73) and 9.80 (8.93-10.67) years respectively. Conclusion: This centre's short-term graft survival of 95.4% is comparable to the best centres of the world.
SiSli Etfal Hastanesi Tip Bulteni / The Medical Bulletin of Sisli Hospital, 2019
E nd-stage kidney disease is a worldwide health problem that can be defined as a burden, with a prevalence rate of 11-13%. [1] Definitive treatment of end-stage kidney disease is kidney transplantation, which provides better clinical outcomes, including overall survival compared to longterm dialysis treatment. [2, 3] A one-year graft survival rate of the transplanted kidney is increased to over 90% by the advances in tissue sampling and immunosuppression. [4] In 2016, 89.823 kidney transplant surgeries were performed worldwide. 40.2% of these transplants were from living donors and 59.8% were from deceased donors. [5] Clinical results of living donor kidney transplantation are two times better than deceased donor kidney transplantation. [1] Paired kidney exchange transplantation is an al-Objectives: The renal transplant program of Istanbul Okan University Hospital started in August 2017. Five cadaveric and 95 living donor kidney transplants have been performed for over 16 months. In this study, we aimed to share our experiences regarding kidney transplantation. Methods: In this study, a retrospective analysis of 100 patients who underwent kidney transplantation at the Istanbul Okan University over 16 months, the Health Application and Research Center was carried out. Patients' demographics, creatinine levels of donors and recipients, co-morbid conditions, postoperative complications, features of arterial anastomosis and arterial variations observed on computed tomography angiography of donor-patient were assessed. Results: Mean age of donor patients was 44.05±13.76 (18-71) years. All living donors had computed tomography angiography for assessment of the vascular structure of both kidneys. Accessory right kidney artery was the most dominant vascular variation (16.5%). The primary cause of chronic renal disease was diabetes mellitus (36.4%) and hypertension (15.6%). Mean warm and cold ischemia time was 1.82±0.44 (1-3) and 40.25±6.12 (31-57) minutes, respectively. The most observed postoperative complication was stenosis of ureter anastomosis (4.1%). End-to-end arterial anastomosis between renal and internal iliac arteries was the most preferred anastomosis (57.2%). Conclusion: Increasing kidney transplantation, which is the most appropriate treatment in terms of cost-effectiveness, will be beneficial for patient health and economy of the country.
Expanding the donor pool to increase renal transplantation
Nephrology Dialysis Transplantation, 2005
Introduction. The goal of the Eurotransplant renal allocation scheme is to provide every patient on the waiting list with a reasonably balanced opportunity for a donor offer. New initiatives were taken in order to maximize donor usage while maintaining a successful transplant outcome. Methods. Two Eurotransplant projects were launched in order to accommodate changes in donor and recipient profiles. A re-addressing of the non-heart-beating donor pool was undertaken and an allocation scheme in which organs from donors aged >65 are allocated to recipients aged >65 [the Eurotransplant Senior Programme (ESP)] was introduced.
Trends in mortality and graft failure for renal transplant patients
2000
Background: Several important advances in general medical management both be- fore and after renal transplantation have occurred over the last 5-15 years, how- ever, few studies have formally examined trends in the outcomes of renal trans- plantation. We, therefore, aimed to determine the degree to which these advances have resulted in improved outcomes such as survival of patient and graft.
Guidelines on Renal Transplantation
2003
Policies to enhance living donation 2.3.1 Medical methods to increase number of living donations 2.3.1.1 Acceptance of grafts with anatomical anomalies 2.3.1.2 Laparoscopic living-donor nephrectomy 2.3.1.3 References 2.3.1.4 ABO-incompatible donors 2.3.1.5 Cross-match-positive living-donor kidney transplants 2.3.1.6 Living unrelated kidney donation 2.3.1.7 'Non-directed' living-donor transplantation 2.3.1.8 Payment to living donors from a central organisation 2.3.1.9 References 2.3.2 Ethical ways of showing appreciation for organ donation 2.3.2.1 Donor 'medal of honour' 2.3.3 Organisational ways to encourage organ donation 2.3.3.1 Cross-over transplantation or paired organ exchange 2.3.3.2 Medical leave for organ donation 2.3.4 References 2.4 Kidney donor selection and refusal criteria 2.4.1 Introduction 2.4.2 Infections 2.4.3 Special exceptions for infections 2.4.4 Malignant tumours 2.4.5 Special exceptions for malignant tumours 2.4.6 Vascular conditions and renal function 2.4.7 Marginal donors 2.4.8 One graft or two grafts per recipient 2.4.9 References 2.5 Explantation technique 2.5.1 Technique of deceased donor organ recovery 2.