RESUMO
The Kidney Donor Risk Index (KDRI) and Kidney Donor Profile Index (KDPI) have been developed to assess deceased-donor graft quality, although validation of their utility outside the USA remains limited. This single-center retrospective cohort study evaluated the ability of KDRI and KDPI to predict transplant outcomes in a Greek cohort. The efficacy of KDRI, KDPI, and donor's age in predicting death-censored graft failure was primarily assessed. Overall, 394 donors and 456 recipients were included. Death-censored graft survival was significantly worse with increasing KDRI (hazard ratio-HR: 2.21, 95% confidence intervals-CI: 1.16-4.22), KDPI (HR: 1.01, 95% CI: 1.00-1.02), and donor's age (HR: 1.03, 95% CI: 1.00-1.05). The unadjusted discriminative ability was similar for KDPI (C-statistic: 0.54) and donor's age (C-statistic: 0.52). The KDPI threshold of 85 was not predictive of graft failure (p-value: 0.19). Higher KDPI was linked to delayed graft function and worse kidney function, but not among expanded-criteria donor transplantations. No significant association was found between KDRI, KDPI, and patient survival. In conclusion, increasing KDRI and KDPI are linked to worse graft function, although their ability to discriminate long-term graft failure remains limited.
RESUMO
BACKGROUND: Ureteral injuries are not very common and can occur after many surgical procedures. Kidney salvage is desirable. Renal autotransplantation is a final option for some cases. In this case, we report an autotransplantation of the kidney after an iatrogenic injury of the ureter with totally extraperitoneal approach. CASE REPORT: A 41 years old female underwent left endoscopic ureterolithotomy with holmium laser for ureteral calculi. An iatrogenic ureteral injury, probably ureteral avulsion, occurred. After multiple interventions, she referred to us with a nephrostomy tube. Imaging was performed and left renal autotransplantation was chosen as surgical management. The approach was totally extraperitoneal. No alteration of renal function or of urine outflow was observed during the follow up. CONCLUSIONS: The report supports the safety and efficacy of renal autotransplantation.
Assuntos
Transplante de Rim/métodos , Litotripsia a Laser/métodos , Ureter/lesões , Cálculos Ureterais/terapia , Adulto , Feminino , Seguimentos , Humanos , Doença Iatrogênica , Transplante AutólogoRESUMO
OBJECTIVES: Surgical incision infections, along with urinary tract infections, are among the most common infective complications after kidney transplant. The aim of this retrospective study is to evaluate the incidence and predisposing factors of surgical incision infection development in renal transplant recipients. MATERIALS AND METHODS: Between 1 January 2012 and 31 December 2015, there were 238 consecutive kidney transplant procedures performed in our unit. Of these, 146 patients received deceased donor kidney allografts and 92 had transplants from living related donors. Deceased donor data, data about surgical procedures, and recipient data were collected. RESULTS: This study demonstrated a surgical incision infection rate of 7.56%. Predisposing factors were found to be kidneys from deceased donors, antithymocyte globulin as antirejection therapy, body mass index > 30 kg/m2, cold ischemia time > 16.3 hours, delayed graft function, postoperative serum glucose > 280 mg/dL, second kidney transplant, and BK virus infection. CONCLUSIONS: Surgical incision infection is a common postoperative infection after kidney transplant. The findings of this study elucidated the potential role of specific risk factors in surgical incision infection development (increased cold ischemia time, delayed graft function, antithymocyte globulin administration). Further evaluation of these findings in a prospective study is needed to avoid potential bias.
Assuntos
Transplante de Rim/efeitos adversos , Infecção da Ferida Cirúrgica/epidemiologia , Adulto , Idoso , Soro Antilinfocitário/uso terapêutico , Isquemia Fria/efeitos adversos , Função Retardada do Enxerto/epidemiologia , Feminino , Grécia/epidemiologia , Humanos , Imunossupressores/uso terapêutico , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/microbiologia , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: The risk of renal cell carcinoma (RCC) development in renal transplant recipients is 15-100 times higher than in the general population. The majority of RCCs found in renal transplant recipients develop in the recipient's native kidneys, only 9% of tumors develop in the allograft itself. The mechanisms of development of RCC in native kidneys and renal allografts are not completely understood. We present our experience in renal transplant recipients with RCC of native kidneys providing valuable and clinically applicable treatment and follow-up data. PATIENTS AND METHODS: The records of 2,173 patients who underwent renal transplantation in our Department between March 1983 and December 2015 were retrospectively reviewed. Using these data, we analyzed the incidence and types of post-transplant RCCs, as well as their clinical courses, focusing on native malignancies. RESULTS: We found 11 RCCs (0.5%) during the observation period in native kidneys. The mean (±SD) follow-up period was 50.54±32.80 months. Four patients died during this period (36.4%). CONCLUSION: Most RCCs in renal transplant recipients are low-stage, low-grade tumors with a favorable prognosis. Their diagnosis is usually incidental. RCC development in the native kidney of renal transplant recipients is an early event, frequently observed within 4 to 5 years after transplantation. The different natural history of these tumors is still undefined. Further research is needed to determine whether these differences are due to particular molecular pathways or to biases in relation to the mode of diagnosis.
Assuntos
Carcinoma de Células Renais/diagnóstico , Neoplasias Renais/diagnóstico , Transplante de Rim/métodos , Transplante de Rim/estatística & dados numéricos , Adolescente , Adulto , Idoso , Carcinoma de Células Renais/epidemiologia , Carcinoma de Células Renais/etiologia , Feminino , Grécia/epidemiologia , Humanos , Incidência , Neoplasias Renais/epidemiologia , Neoplasias Renais/etiologia , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Fatores de Tempo , Adulto JovemRESUMO
OBJECTIVES: Intestinal perforation remains a clinical challenge and potentially lethal complication in renal transplant recipients. Immunosuppression not only places the patient at risk for intestinal perforation but also masks classic clinical symptoms and signs of acute abdominal pain, leading to delayed diagnosis and proper treatment. The aim of our study is to present the experience of our center on the treatment of intestinal perforation in renal transplant recipients. MATERIALS AND METHODS: This study reported 11 patients (0.52%) with intestinal perforation among a group of 2123 patients who received renal transplants in the Transplantation Unit at Laikon General Hospital in Athens, Greece from 1983 to August 2015. RESULTS: One patient died from septic shock before any surgery, and 3 patients died during the early postoperative period, resulting in a morality rate of 36.3%. All patients who died had a functioning graft. From the patients who were discharged, the mean follow-up was 16 months (range, 4-32 months). CONCLUSIONS: Intestinal perforation after renal transplant is a major and potentially lethal complication. Clinical presentation is usually equivocal, and the transplant surgeon should be highly suspicious when treating a renal transplant recipient with acute abdominal pain, even in cases without other predisposing factors (diverticulitis, ischemic colitis, and so forth), so that this condition could be investigated and unmasked.
Assuntos
Perfuração Intestinal/epidemiologia , Transplante de Rim/efeitos adversos , Dor Abdominal/etiologia , Dor Aguda/etiologia , Adulto , Idoso , Feminino , Sobrevivência de Enxerto , Grécia/epidemiologia , Mortalidade Hospitalar , Hospitais Gerais , Humanos , Imunossupressores/uso terapêutico , Perfuração Intestinal/diagnóstico , Perfuração Intestinal/mortalidade , Perfuração Intestinal/cirurgia , Transplante de Rim/mortalidade , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVES: We report the incidence and pattern of malignancies in renal transplant recipients from our department. MATERIALS AND METHODS: Between March 1983 and August 2013, the records of 2054 renal transplant recipients from our department were retrospectively reviewed with regard to type of neoplasm, age, gender, interval between the transplant and the diagnosis of malignancy, immunosuppressive regimens, graft functional status, and rejection episodes. RESULTS: Among the 2054 renal transplant recipients, visceral malignancies developed in 74 patients (3.6%). The mean age at transplant was 43.9 years, and the mean age at death was 61.9 years. Sixty-eight patients (91.9%) died with a functioning graft. Fifty-four (73%) died during follow-up. The mean time from transplant to malignancy was 96.4 months, and from malignancy to death was 27.5 months. No difference regarding the type of immunosuppression, the type of donor, or the interval between transplant and malignancy was detected when we compared cancers. CONCLUSIONS: Malignancies after a renal transplant display aggressive behavior and occur more frequently several years after the transplant, but they also may occur earlier. The type of immunosuppression, the type of donor, or the interval between transplant and malignancy do not differ significantly among cancers.
Assuntos
Transplante de Rim/efeitos adversos , Neoplasias/epidemiologia , Adulto , Idoso , Feminino , Rejeição de Enxerto/epidemiologia , Rejeição de Enxerto/imunologia , Sobrevivência de Enxerto , Grécia/epidemiologia , Humanos , Imunossupressores/uso terapêutico , Incidência , Masculino , Pessoa de Meia-Idade , Neoplasias/diagnóstico , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Renal transplantation is associated with an increased incidence of nonmela-noma skin cancer (NMSC) caused by immunosuppression. Squamous cell carcinoma (SCC) and basal cell carcinoma (BCC), the two major histological types of NMSC, exhibit more aggressive biological and clinical courses in renal transplant recipients (RTRs), with higher rates of recurrence and mortality than in the general population. METHODS: We retrospectively analyzed our experience of NMSC in 1736 renal transplantations performed over a 25-year period. All cases of skin cancer after renal transplantation were included except those of skin cancer resulting from melanoma and mesenchymal skin tumors. RESULTS: In our series, the overall incidence of NMSC after transplantation was 2.2% (n = 39), and SCC represented the most frequent skin malignancy (64.1%), followed by BCC (17.9%), Bowen's disease (10.2%), basosquamous carcinoma (5.1%), and a rare case of invasive sebaceous carcinoma (2.6%). A shift to newer immunosuppressive regimens after the initial diagnosis of NMSC had been implemented in eight cases (20.5%). The recurrence rate after initial treatment was 41% (n = 16), and distant metastatic disease was diagnosed in 15.4% (n = 6) of NMSC patients. The NMSC-specific mortality rate was 25.6% (n = 10). CONCLUSIONS: Nonmelanoma skin cancer remains a significant source of morbidity and mortality in RTRs, and post-transplant surveillance should be increased.
Assuntos
Carcinoma Basocelular/etiologia , Carcinoma de Células Escamosas/etiologia , Terapia de Imunossupressão/efeitos adversos , Imunossupressores/efeitos adversos , Transplante de Rim/efeitos adversos , Neoplasias Cutâneas/etiologia , Adenocarcinoma Sebáceo/epidemiologia , Adenocarcinoma Sebáceo/etiologia , Adulto , Idoso , Carcinoma Basocelular/epidemiologia , Carcinoma de Células Escamosas/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/etiologia , Estudos Retrospectivos , Neoplasias das Glândulas Sebáceas/epidemiologia , Neoplasias das Glândulas Sebáceas/etiologia , Neoplasias Cutâneas/epidemiologia , Adulto JovemRESUMO
BACKGROUND: The utilization of kidney grafts from expanded criteria donors (ECDs) needs to be evaluated within the context of critical organ shortage and graft function and survival. The impact of donor risk variables on kidney transplantation (KTx) outcome was investigated. METHODS: A retrospective review of 75 KTxs from ECDs over a 5-year period was performed. Donor risk factors were analyzed separately and correlated with recipients graft function and survival. RESULTS: Sixty-four recipients out of 75 (85.3%) had functioning grafts 5 years post-transplant. The overall actuarial graft survival rates at 1 through 5 years were 87.5, 68.1, 57.3, 55.4, and 47.3%, respectively. Forty-seven kidneys (62.7%) had early function with actuarial survival of 100.0, 88.3, 75.8, 75.8, and 68.4% at 1-5 years post-transplant, and 28 (37.3%) grafts presented delayed function with substantially decreased actuarial survival, ranging from 66.7 to 23.2%. KTxs from elderly donors had remarkable actuarial survival rates ranging from 100.0 to 67.0%, at 1-5 years, being the best graft survival rates among KTxs from other donor categories. The other donor risk variables when associated with old age had an adverse effect on recipient graft function and survival, but none alone or a combination of the two, showed any significant statistical variability. CONCLUSION: ECDs significantly increased the kidney pool and can be utilized safely if adequate measures are taken.
Assuntos
Análise Atuarial , Transplante de Rim , Doadores de Tecidos , Obtenção de Tecidos e Órgãos/normas , Fatores Etários , Função Retardada do Enxerto , Rejeição de Enxerto , Sobrevivência de Enxerto , Grécia , Humanos , Tempo de Internação , Sistema de Registros , Estudos Retrospectivos , Taxa de Sobrevida , Fatores de TempoAssuntos
Artéria Ilíaca/cirurgia , Veia Ilíaca/cirurgia , Falência Renal Crônica/cirurgia , Transplante de Rim/métodos , Artéria Renal/cirurgia , Veias Renais/cirurgia , Adulto , Anastomose Cirúrgica , Feminino , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/etiologia , Masculino , Nefrite Hereditária/complicações , Duração da Cirurgia , Artéria Renal/anormalidades , Resultado do TratamentoRESUMO
De novo carcinoma of the renal transplant is a rare but disastrous clinical entity. We report such a tumor developing 13 years after transplantation and describe its clinical presentation, diagnostic approach and therapy. The importance of a surveillance program allowing early detection of tumor developing in the renal transplant is emphasized.
Assuntos
Carcinoma de Células Renais/etiologia , Neoplasias Renais/etiologia , Transplante de Rim/efeitos adversos , Carcinoma de Células Renais/diagnóstico , Carcinoma de Células Renais/cirurgia , Humanos , Neoplasias Renais/diagnóstico , Neoplasias Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Fatores de TempoRESUMO
The incidence of Kaposi's sarcoma (KS) in transplant recipients is 400-500 times greater than that in the general population, and is rising within the transplant population. In this study, between March 1983 and December 2001, 1055 cases were recorded where KS developed in 18 patients (1.7%) who were treated with AZA + CsA + MP, MMF + CsA + MP, MMF + Tac + MP, CsA + MP, or AZA + MP therapy (AZA, azathioprine; CsA, cyclosporine A; MP, methylprednisolone; MMF, mycophenolate mofetil; Tac, Tacrolimus). In the present study, 18 renal transplant recipients who developed KS and were followed and analyzed. Analysis revealed that a continuous state of immunodeficiency is important for the development of KS. Prognosis in patients with KS limited to the skin is favorable, while visceral involvement is associated with high mortality. Transplant function is well preserved in most of the cases. The association, previously described, between human herpesvirus 8 (HHV8) and transplant-associated KS also exists in the studied population.