Risk factors for the development of delayed graft function in deceased donor renal transplants.

INTRODUCTION: Delayed renal graft function (DGF) is associated with various factors and with a higher complication rate in the posttransplant period. Determination of center-specific risk factors may help to reduce the incidence of DGF and improve transplantation results. The aim of this study was to define risk factors for the development of DGF after renal transplantation. PATIENTS AND METHODS: This study included 290 consecutive deceased donor renal transplantations performed in a single center between January 1, 2004, and November 30, 2007. All cases were examined for the presence of DGF, defined as the need for at least 1 dialysis during the first posttransplant week. The subjects were divided into 2 groups: immediate graft function and DGF. Both groups were compared for donor and recipient transplantation factors as well as early posttransplant results. RESULTS: DGF was observed in 61 cases (21%). Our analysis revealed associations of DGF with recipient age (P = .011), female gender (P = .028), donor age (P = .033), body mass index (P = .007), severe hemodynamic disturbances (P = .005) preexistent glomerular or interstitial sclerosis (P = .002 or P = .028, respectively); and cold ischemia time (CIT; P = .019). Trends toward significance were observed with recipient weight > 100 kg (P = .078), and diabetes mellitus (P = .109). Recipients who experienced DGF showed on higher rate of acute rejection, a longer hospital stay, and an higher level serum creatinine at discharge (P < .001 for all). CONCLUSION: DGF had deleterious effects in the early posttransplant period. Careful allocation and reduction of CIT may improve transplantation results.

Donation and transplantation in Latvia--2006.

The 75 kidney transplant operations (32.6 per million population per year) and 2 heart transplant operations were performed in 2006 in Latvia. This represents a slight decrease of 3% compared to 2005. 86 kidneys were procured from 43 deceased donors. There were 46% donors with brain death and 54% non-heart-beating donors among them. During last decade the donor rate increased from 10.9 per million population in 1996 to 18.7 per million population in 2006. In our center patient survival was 93.2% at 1 year and 87.4% at 5 years, and graft survival was 84.5% at 1 year and 72.3% at 5 years. Such transplantation activity ensures mean waiting time of 6-7 months for patients accepted for kidney transplantation.

Vascular access outcomes as a predictor of development of chronic allograft nephropathy.

INTRODUCTION: The vascular condition influences the outcomes of arteriovenous fistula (AVF) surgery. However, it has not been established how it influences the outcomes of renal transplantation and the development of chronic allograft nephropathy (CAN). The aim of this study was to define the relationship between AVF failure in the pretransplant period and the development of CAN. PATIENTS AND METHODS: In this study we included all patients who underwent AVF surgery and then first kidney allotransplantations from January 1, 1999 to December 31, 2002. Patients were divided into two groups according to the AVF surgery outcomes: group 1 (n = 45, mean age 50 +/- 13 years, male/female ratio 27/18) had no vascular access complications and were dialysed through a native AVF. Group 2 (n = 39, mean age 51 +/- 11 years, male/female ratio 17/22) had additional interventions due to AVF failure. We analyzed the incidence of CAN in both groups. RESULTS: During the follow-up period CAN was observed in five patients in group 1 and 11 patients in group 2 (11,1% vs 28,2%, P < .05). There was a statistically significant relationship between CAN and acute rejection episodes (P < .005) and diabetes mellitus (P < .05). CONCLUSION: Failures of arteriovenous fistulas in hemodialysis patients were associated with an increased incidence of CAN in the posttransplant period.

Organ and tissue transplantation in Latvia.

From 1973 to May, 1996 585 kidney transplantations were performed in the Department of Transplantation. From 1983 to 1988 investigations on transplantation of pancreas islet cell culture were carried out. Because of financial difficulties these investigations had to be stopped. In 1992 a law was adopted which regulates organ removal for transplantation by the "option out" system. In 1996, a transplantation association of the Baltic countries, Balttransplant, which includes the Latvian Department, began to function. Work of this association in the field of transplantation coordination has lead to an increase of donor kidneys and improvement of graft quality. The center performs 14-16 transplantations of kidneys per 1 million of population every year. The patient one year survival rate is 87%, survival of transplants--72-75%. Further progress of transplantation in Latvia will be possible only if the economic conditions and progress in medicine in general improve.