Impact of donor and recipient age difference on long-term allograft survival after living donor renal transplantation: analysis of 478 cases.

INTRODUCTION: Either deceased or living-related renal transplantation constitutes the best therapeutic option for patients with end-stage renal disease. In this retrospective study, an attempt to identify parameters that affect allograft survival in living donor renal transplantation was made. METHODS: Between January 2000 and July 2012, 478 adult patients received a renal transplant from a living-related donor in our center and their records were retrospectively reviewed in November 2012. Data concerning donor age, recipient age, donor/recipient age difference, donor/recipient gender, and ABO compatibility/incompatibility were recorded and associated with renal allograft survival rate. RESULTS: Renal allograft survival rate was 96%, 89.5%, and 77.7% in the first, fifth, and 10th yr after transplantation, respectively. Only the difference between donor and recipient age was statistically significant in relation to graft survival. In cases with age difference >13 yr, graft survival rate was lower from the third yr onward. CONCLUSIONS: Only the age difference between donor and recipient exerts an adverse impact on graft outcome after living donor renal transplantation, whereas donor age, recipient age, donor/recipient gender, and ABO incompatibility do not significantly influence renal allograft survival.

Incisional Infections after Renal Transplant: Outcome Data From 238 Consecutive Recipients.

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.

De Novo Renal Cell Carcinoma of Native Kidneys in Renal Transplant Recipients: A Single-center Experience.

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.

Shortening a Carrel Patch in a Graft With Multiple Arteries: A Step-By-Step Technical Analysis.

OBJECTIVES: Multiple renal arteries in donor kidneys are not a rare entity. Whenever encountered, they pose a surgical challenge in renal transplant because they require a more complicated back table vascular reconstruction and implant technique. We developed a unique step-by-step in vivo illustration of the application of shortening a Carrel (aortic) patch to address multiple arteries in deceased-donor renal transplant. MATERIALS AND METHODS: Case report. RESULTS: We present the case of a 63-year-old man who received a left kidney from a deceased donor with 2 arteries on a Carrel patch that were anastomosed in a neopatch model. CONCLUSIONS: A donor kidney with multiple arteries is a challenge before arterial anastomosis. Various anastomotic patterns have been described for this situation. Treatment of multiple arteries depends mainly on the donor source (living or deceased), the characteristics of multiple arteries, and the transplant surgeon's preference. When the length of the aortic patch of a deceased donor is > 2.5 cm, the surgeon may shorten it and form a neopatch to facilitate a single arterial anastomosis to the recipient.

Intestinal Perforation in Renal Transplant Recipients: A Single Center Experience of 2123 Recipients.

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.

Clostridium difficile infection among kidney transplant recipients: frequency, clinical presentation, and outcome.

The objective of this study was to evaluate the frequency of Clostridium Difficile Infection (CDI) among kidney transplant recipients and describe the clinical picture in correlation with the presence of certain risk factors. We included kidney transplant recipients with a functioning graft, who were admitted during the period 1/2012-12/2013, and patients with ESRD who were admitted to undergo Kidney Transplantation (KTx) from a deceased or a living donor in the same period. Patients were screened following clinical indication of gastrointestinal infection. CDI diagnosis was based on a positive stool sample for CD toxins and stool culture. Within the period 2012-2013, we recorded 24 cases of CDI in 19 patients, accounting for a frequency of 5.4% of CDI in our population. In addition to diarrhea, 63.15% of the patients presented with fever, 31.25% with anorexia, while abdominal pain was a rare symptom (0.53%). None of the patients had ileus, bowel obstruction or megacolon. Fourteen patients (73.7%) had a history of recent exposure (15 days) to antimicrobial agents prior to the evolution of CDI symptoms. A relapse of the CDI infection was identified in five cases. CDI infection is a significant factor of morbidity in patients with KTx and should be considered in the clinical setting of diarrhea, even in cases with no exposure to antibiotic agents.

De Novo Visceral Malignancies in Renal Transplant Recipients: A Single Center Experience of 2054 Recipients for More Than 30 Years.

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.

An uncommon cause of acutely altered mental status in a renal transplant recipient.

INTRODUCTION: Neurological complications are quite frequent in patients after solid organ transplantation presenting with focal or generalized neurologic symptoms as well as altered mental status. Posterior reversible encephalopathy syndrome is a rare cliniconeuroradiological entity characterized by headache, altered mental status, cortical blindness, seizures, and other focal neurological signs and a diagnostic magnetic resonance imaging. CASE REPORT: We present a case of a 57-year-old woman with one episode of seizures and sudden onset of altered mental status (time and person perception) accompanied with headache at the thirtieth postoperative day after renal transplantation. CONCLUSION: Posterior reversible encephalopathy syndrome, although an uncommon post-renal transplantation complication, should be considered in these patients, as several factors surrounding the setting of transplantation have been implicated in its development. Thus, physicians should be aware of this condition in order to establish the diagnosis and offer appropriate treatment.