Effects of bisphosphonates on long-term kidney transplantation outcomes.

BACKGROUND: Bisphosphonates are administered to post-transplantation patients with mineral and bone disorders; however, the association between bisphosphonate therapy and long-term renal graft survival remains unclear. METHODS: This nested case-control study investigated the effects of bisphosphonates on long-term graft outcomes after kidney transplantation. We enrolled 3836 kidney transplant recipients treated from April 1979 to June 2016 and matched patients with graft failure to those without (controls). Annual post-transplant bone mineral density assessments were performed and recipients with osteopenia or osteoporosis received bisphosphonate therapy. The associations between bisphosphonate use and long-term graft outcomes and graft survival were analyzed using conditional logistic regression and landmark analyses, respectively. RESULTS: A landmark analysis demonstrated that death-censored graft survival was significantly higher in bisphosphonate users than in non-users in the entire cohort (log-rank test, P < 0.001). In the nested case-control matched cohort, bisphosphonate users had a significantly reduced risk of graft failure than did non-users (odds ratio = 0.38; 95% confidence interval 0.30-0.48). Bisphosphonate use, increased cumulative duration of bisphosphonate use >1 year and increased cumulative bisphosphonate dose above the first quartile were associated with a reduced risk of graft failure, after adjustments. CONCLUSIONS: Bisphosphonates may improve long-term graft survival in kidney transplant recipients.

Pediatric liver transplantation outcomes in Korea.

Pediatric liver transplantation is the standard of care for treatment of liver failure in children. The aim of this study was to identify the characteristics of pediatric liver transplantation in centers located in Korea and determine factors that influence outcomes. This retrospective study was performed using data from between 1988 and 2010 and included all recipients 18 yr old and younger who underwent pediatric liver transplantation in Korea during that period. Our data sources were hospital medical records and the outcome measure was overall patient survival. Univariate and multivariate statistical analyses were undertaken using the Cox proportional hazards model. Five hundred and thirty-four pediatric liver transplantations were performed in 502 children. Median age and average pediatric end-stage liver disease (PELD) score were 20 months and 18 point, respectively. Biliary atresia (57.7%, 308/534) was the most common cause of liver disease. Eighty-two (15.3%) were deceased donor liver transplantations and 454 (84.7%) were living donor liver transplantations. Retransplantation was performed in 32 cases (6%). Overall, 1-, 5-, and 10-yr patient survival rates were 87.8%, 82.2%, and 78.1%, respectively. In multivariate analysis, independent significant predictors of poor patient survival were chronic rejection and retransplantation. This study presents the epidemiologic data for nearly all pediatric liver transplantation in Korea and shows that the independent prognostic factors in patient survival are chronic rejection and retransplantation.

Ureteral nephrogenic adenoma in a renal allograft patient.

A 56-year-old male who had renal transplants at the age of 34 and 49 years, presented with painless gross hematuria six years after the second renal transplantation. An abdominal computed tomography scan revealed diffuse wall thickening of the distal ureter of the failed first allograft and a bulging lesion about 1.2 cm in size on the lower pole of the right native kidney. Both lesions were suspected for tumors, but they showed a ureteral nephrogenic adenoma and a renal hemorrhagic simple cyst.

Favorable outcomes among recipients of living-donor nephrectomy using video-assisted minilaparotomy.

BACKGROUND: Minimally invasive, living-donor nephrectomy (LDN) is an attractive procedure for the donor in kidney transplantation (KTx). Its advantages include better cosmesis, shorter hospital stay, and rapid recovery. The most commonly performed, minimally invasive nephrectomy is done laparoscopically. However, the technical challenges, a steep learning curve for the surgeon, the risk of impaired early graft function, and the high cost of the procedure, have prevented minimally invasive LDN from gaining wide acceptance. To overcome these problems, we have developed a new surgical procedure named video-assisted minilaparotomy (VAM) for LDN. VAM-LDN is performed entirely with a small retrieval incision. Moreover, it does not require the induction of pneumoperitoneum, thereby avoiding potential vascular and renal complications. METHODS: We evaluated the outcome of transplant recipients receiving kidneys with the VAM-LDN procedure by retrospectively comparing the surgical outcomes of patients who underwent KTx with the conventional open nephrectomy (group I, n=82) and VAM-LDN (group II, n=70) procedures from March 1, 1997, to June 30, 2002, at our institution. We compared postoperative complications, patient and graft survival, and graft functions between these two groups during a 12-month follow-up period. RESULTS: There were no differences in demographic data, ABO compatibility, degree of human leukocyte antigen matching, or method of immunosuppression between the two groups (P >0.05). No significant difference was observed in complications such as delayed graft function, acute rejection, ureter complication, graft failure, or patient's mortality. There was no difference in graft function between the two groups, as determined by serum creatinine level measured during the 12-month follow-up. CONCLUSION: The short-term recipient outcome was favorable in patients who underwent KTx with the VAM-LDN procedure.

Kidney transplantation in Yonsei University from 1979-2003.

1. Long-term graft survival has been markedly improved after the introduction of CsA microemulsion and FK-506 as our main immunosuppressants, and the use of triple maintenance immunosuppression including MMF in living-donor kidney transplantation (KTX) at Younsei University. 2. The risk factors affecting long-term graft survival in living-donor KTX were recipient and donor age, type of immunosuppression including regimen, presence of pretransplant diabetes or hepatitis B, and the development of acute rejection after KTX. 3. The long-term graft survival rate with living-unrelated donor KTX was comparable to that with HLA-haploidentical living-related donor KTX. 4. Because of the striking disparity between organ donation and the increasing demand for KTX, distant relatives, living unrelated donors (including swap donors) should be considered as an alternative approach to increasing the number of available donors when accompanied by a careful evaluation process. 5. We recommend the use of minimally invasive approaches to donor nephrectomy to increase the rate of living donor donation. 6. We recommend negative lymphocyte crossmatch conversion protocols for patients with a positive crossmatch against their potential living donor.