Comparison of accepted and unaccepted living kidney donors: one-center experience.

BACKGROUND: Kidney transplantation from living donors (LD) has stagnated in many countries. This study aimed to check whether correction of LD selection practice could increase the number of kidney transplantations. METHODS: From January 2003 to December 2012, 241 potential adult LD were evaluated in our hospital. Outcome (mortality and end-stage renal disease-ESRD) of accepted LD (182) was compared with unaccepted (59) donors. RESULTS: Mortality of LD was comparable with that for the standardized Serbian population (SMR = 1.104; 95% CI (0.730-1.606). Among evaluated potential LD, almost every fourth had been unaccepted, but reasons were modifiable in 42.4% of them. In pre-donation period unaccepted donors were significantly older, measured glomerular filtration rate was lower, with higher 15-year and lifelong projected ESRD risks than accepted donors. Despite this, ten years outcome of both groups LD was similar: none of LD developed ESRD, 9.8% of accepted and 11.8% of unaccepted LD died (p = .803). CONCLUSIONS: During an average of 101 months of follow-up mortality of accepted LD did not differ significantly as compared to the age standardized Serbian population and none of them developed ESRD. In examination of potential LD, the use of accurate and precise methods for kidney function estimation and the evaluation of risk for ESRD and mortality as well as treatment of modifiable contraindications for kidney donation are necessary.

Malignant disease in renal transplant recipients--our experience.

Kidney transplantation is a treatment of choice for patient with end stage renal disease. Chronic renal failure is characterized with weak cellular and humoral immunity. In our paper we present our experience with presence of malignancy in renal transplant patients. Urology clinic in Belgrade transplanted 411 patients over the period of 16 years. Living donor transplantation was performed for 272 and cadaveric kidney transplant for 139 patients. In the postoperative follow up, malignancies were diagnosed in 7 of the transplanted patients. Three patients developed basal cell skin carcinoma, one was diagnosed with adenocarcinoma of the transplanted kidney, one developed transitional cell carcinoma of the bladder and testicular tumors were diagnosed in two patients. Postoperative immunosuppressive therapy usually double or triple when patients are in the immunological high risk group. Incidence of malignancy according to big health centers is around 1 in every 1000 transplanted patients. It is also noted the rise of incidence of malignancies in transplanted patient in over 50%.

[Cystatin C as a measure of glomerular filtration in patients with kidney transplants]. / Cistatin C kao mera jacine glomerulske filtracije kod bolesnika sa transplantiranim bubregom.

INTRODUCTION: Assessment of renal function is of great importance in clinical medicine, especially in renal transplant patients requiring frequent controls of renal function. Therefore, continuous efforts have been made in searching precise and simple method for determination of glomerular filtration rate (GFR). Serum level of cystatin C (CyC), protein of low molecular weight, has been proposed as measure of GFR, but the data of its value in renal transplant patients are scarce [8-10]. PURPOSE: The aim of this study was to compare the serum levels of low molecular weight proteins CyC and beta 2-microglobulin (beta 2-MG) with creatinine clearance, as well known measure of GFR, in renal transplant patients and control group of patients with different renal disease. PATIENTS AND METHODS: The study included 36 patients divided into two groups. Group 1: 20 renal transplant patients (12 men and 8 women) aged between 22 and 63 (40.4 +/- 10.1) years with creatinine clearance from 7.1 to 77.7 ml/min. Group 2: 16 controls (5 men and 11 women) with various renal diseases, aged between 24 and 63 (41.5 +/- 12.5) years with creatinine clearance from 60.5 to 116.8 ml/min. N Latex Cystatin C and beta 2-microglobulin for the Behring Nephelometer System was used in this study. Creatinine was determined with Jaffe-reaction in serum and urine. RESULTS: In renal transplant patients as well as in control group of patients the significant correlation between creatinine clearance and reciprocal values of the serum CyC (rt = 0.828; pt < 0.001; rc = 0.603; pc < 0.05) and reciprocal values of the serum beta 2-MG levels (rt = 0.791; pt < 0.001; rc = 0.627; pc < 0.05) was found (Graph 1). There was a slightly better correlation between creatinine clearance and reciprocal values of the serum CyC than the one between creatinine clearance and reciprocal values of the serum beta 2-MG without statistical significance in renal transplant patients. There was no difference in correlation coefficients between both low molecular weight proteins and creatinine clearance in Group 2. The correlation coefficient between serum CyC and beta 2-MG was r = 0.839 (p < 0.001) in renal transplant patients and r = 0.835 (p < 0.05) in control group. There were no significant differences in correlation coefficients between reciprocal values of serum CyC and creatinine clearance (p = 0.2043) as well as reciprocal values of serum beta 2-MG and creatinine clearance (p = 0.3717) between Group 1 and Group 2. DISCUSSION: In renal transplant patients rapid assessment of graft function is necessary. This allows early recognition of rejection as well as differential diagnosis of different renal graft disorders. Study of Risch and co [16] suggested that serum CyC was very good marker for GFR in renal transplant patients which was confirmed by the other authors too [20-22]. During inflammatory process or other pathological conditions, especially during acute rejection or infections. CyC also provided precise assessment of GFR while creatinine clearance varied dramatically [16]. Serum concentration of beta 2-MG, another low molecular weight protein, also depends both on its production rate and the GFR [5, 19]. Its production is dramatically different in patients with infections [5] as well as while immunosuppressive drugs are used [16]. Therefore, beta 2-MG is impractical as GFR marker in patients with renal transplants. So, serum CyC was considered as better marker for GFR than beta 2-MG and creatinine clearance in renal transplant patients with different complications [16]. In this study serum CyC was slightly better marker for GFR than beta 2-MG, without statistical significance (Graph 1). Renal transplant patients, however, were in the stable condition at the time of the study. CONCLUSION: Serum CyC was moderately better marker of GFR than beta 2-MG in renal transplant patients when they were in the stable condition. Serum CyC and beta 2-MG were the same markers of GFR in control group of patients with various renal diseases. There was no significant difference in correlation coefficients between reciprocal values of the serum CyC and creatinine clearance (p = 0.2043) as well as reciprocal values of the serum beta 2-MG levels and creatinine clearance (p = 0.3717) between two examined groups of patients. The studies on renal transplant patients with acute graft rejection or infections are warranted.

[Analysis of living related kidney donors and their postoperative course]. / Izbor zivih srodnih davalaca za transplantaciju bubraga i njihov postoperacioni tok.

Lack of cadaveric organs for transplantation resulted in increased number of living related kidney donors examinations and consequent transplantations in our Department. Donor procedure, selection, drop-outs and final results for living related donors (LRD) were retrospectively analyzed in this paper. Between 1987 and 1994 202 potential LRD were examined. Most of them were females (59%) and about 30% were older than 60 years. The family relation between LRD and recipients were: parents (95%), siblings (3%), grandmother/grandfather (1.5%) and uncle (0.5%). Potential LRD were informed on risks, advantages and procedure of living donor transplantation. After primary information 26% of potential LRD gave up further examinations. Following immunological and clinical evaluations 48% of LRD actually donated a kidney. The other 26% were excluded during the selection procedure. High immunological risks including ABO incompatibility, HLA mismatches and positive cross match test were the reasons for drop outs of 35 potential LRD (17%). Five more donors were excluded for medical reasons: one because of low creatinine clearance and four because of neoplasms, discovered during examination (kidney, laryngeal, lung). Fourteen transplantation were not realized due to different recipient reasons: 5 of them had clinical contraindications, two died and in 7 cadaveric kidney transplantations were performed. Mild hypertension, coronary disease and diabetes mellitus type 2 were presented in 5 LRD accepted for transplantation. Five more had to be operated before donation (abdominal or urological operation). Early complications after donor nephrectomy were acute renal failure, stress ulcus, pleuropneumonia in three and thromboflebitis in two donors. In conclusion, although kidney transplantation from LRD is highly successful, careful examination during selection procedure is indispensable.

[Effect of donor-specific blood transfusion on the outcome of kidney transplantation]. / Uticaj donor-specificnih transfuzija krvi na ishod transplantacije bubrega.

Donor specific transfusion (DST) is proclaimed to improve graft survival in living related kidney transplantation (LRTx). The aim of the present study was to estimate the influence of DST on LRTx graft function, acute rejection rate (AR) and survival in the early and late posttransplant period. Fifty-five LRTx patients (grafted in the same year, and matched for recipients' and donor's age, sex) were included into the study. Ninety pts received DST: 4 patients were excluded from further evaluation (3 developed positive cross match reaction and one patients received cadaver graft) and 15 patients subsequently underwent LRTx from their respective blood donors (group 1). Their outcome was compared with 15 patients who had never been transfused before (group 2) and 25 random transfused patients (group 3). Besides similar patients' and donors' sex and age, kidney transplantations were performed in the same period. Graft functions were followed-up 6-60 months after LRTx. DST protocol consists of 3 x 150 ml potentially related donor's fresh whole blood at 2-week intervals (DST1, DST2, DST3) with 3 days azathioprine administration (2 mg/kg bw, one, day before to one day after DST administration). Donor specific cytotoxic antibodies were determined before DST1, at the day of DST2, DST3 and 14 and 28 days after DST3. All patients were grafted at least one month after the DST3. Immunosuppressive protocol consisted of three drugs. There is no difference in HLA mismatches, MLC answer, and pretransplant panel reactive antibodies level between groups. One patient from group 2 lost their graft in the first postTx month (acute tubular necrosis). A better graft function was preserved in patients from groups 1 and 3 than group 2 in the observed periods. Number of patients with acute rejection was unsignificantly different: 5/15 from group 1, 12/25 from group 3 but 8/10 patients from group 2. However, the acute rejection rate was lower in patients from group 1. One and five-year graft survival was 100% for grafts from groups 1 and 3, while it is gradually decreased for group 2 grafts: 84.5% and 57%. Our results confirmed the beneficial effect of blood transfusion on LRTx renal graft function and survival and DST on the incidence of acute rejection.