Dialysis within 24 hours of transplant does not improve graft function.

OBJECTIVES: Grafts from extended criteria donors, donors after cardiac death, and elderly donors have an increased risk of delayed graft function, lower graft survival, longer hospital stay, higher costs, and increased medical sequelae. A modifiable risk factor for delayed graft function may be the performance of dialysis on the same day as renal transplant. We reviewed our institutional experience to determine whether dialysis performed within 24 hours of engraftment increased the incidence or length of delayed graft function. MATERIALS AND METHODS: We retrospectively reviewed our kidney transplants performed between 2008 and 2012. Preemptive transplants, transplants associated with peritoneal dialysis, potassium > 5 mmol/L, or living donors, and cases with insufficient information were excluded. Data collected included demographic, biochemical, donor, operative, and outcome variables (length of stay, length of delayed graft function, rejection, and a composite unfavorable outcome comprising cardiac and infectious events). Transplants that were associated with hemodialysis within 24 hours before transplant (study group) were compared with the remainder of the cohort (control group). RESULTS: A total of 205 renal transplants were reviewed. There were 144 of 205 transplants (70.24%) in the study group, and the others comprised the control group. The rate of delayed graft function was 31% for the study group and 29% for control groups (P = .4959). Mean length of delayed graft function was 5.8 days for the study group and 6.1 days for control group (P = .7323). Delayed graft function risk factors such as donor age, terminal creatinine, and machine perfusion rate were similarly distributed across both groups. CONCLUSIONS: Normokalemic patients who did or did not undergo dialysis within 24 hours before transplant had equivalent incidence and duration of delayed graft function, graft outcomes, and patient outcomes. Therefore, dialysis within 24 hours before transplant is unnecessary in the setting of normokalemia.

Fate of abstracts presented at the 2009 American Transplant Congress.

INTRODUCTION: Oral and poster presentations at major meetings serve to rapidly present and share study results with the scientific community. On the other hand, full-text publication of abstracts in peer-reviewed journals provides dissemination of knowledge. The purpose of this study was to evaluate the publication rate of abstracts presented at the 2009 American Transplant Congress (ATC), to assess the factors influencing publication and determine the impact factor of these journals. METHODS: All abstracts presented at the 2009 ATC were included in the study. A Pubmed-Medline search was performed to identify a matching journal article. Topics, country of origin, study type, study center and publication year were tabulated. Journals and impact factors of publication were noted. RESULTS: Out of 1938 oral and posters abstracts presented, 103 (16.6%) of oral abstracts and 141 poster abstracts (10.9%) were published as full-text articles. Publication rates according to topics of the meeting and country of origin did demonstrate statistical significant differences (p < 0.05). Single-centered studies had higher publication rates 70.87% (73/103) than multi-centered studies among oral abstracts. Abstracts from multi-centered studies had higher publication rates among poster abstracts (68.09% vs. 31.91%), and the journals they were published in had higher impact factors than single center studies (4.578 vs. 3.897). The median impact factor of the journals was 4.2 (4.8 for oral presentations and 3.627 for poster presentations) that went on to be published as full text manuscripts. When comparing multi-center and single institutions, the difference between 12 month and 24 month publication rates was not statistically significant (p = 0.5443 and 0.1134). However, oral and poster abstracts published by study center (multi/single) did demonstrate a statistically significant difference (p < 0.0001); comparing the type of study, there was also a statistically significant difference between the oral and poster abstract (p < 0.0001). CONCLUSION: The publication rate for abstracts of this 2009 ATC was lower than rates from other fields of medicine. Factors leading to failure require elucidation. Encouraging authors to submit their presentations for full-text publication might improve the rate of publication. Authors should be wary of accepting oral and poster abstracts as dogma; authors should refrain from citing them in publications especially if they are from outside United States and are about liver and kidney transplantation.

Elimination of warm ischemia using the Ice Bag Technique does not decrease delayed graft function.

BACKGROUND: Warm ischemic time (WIT) in kidney transplantation has significant effects on graft survival, function, and postoperative morbidity. We utilized the Ice Bag Technique (IBT) to determine if eliminating WIT would decrease the incidence and length of delayed graft function (DGF) in our cohort. METHODS: We conducted a prospective study of 150 kidney transplants. We compared the elimination of WIT with IBT to traditional methods. Data was analyzed using non-parametric statistical tests. RESULTS: 66 of the 134 patients underwent transplantation using IBT. 28 right kidneys, 34 left kidneys, and 4 dual kidneys were implanted successfully. Patients with a body mass index (BMI) as high as 41 were transplanted. Kidneys with up to three arteries and two veins, and kidneys up to 15.5 by 9 cm in size were safely transplanted into either iliac fossa. Despite the complete elimination of WIT, there was no difference in DGF, length of DGF, length of stay graft rejection, graft survival, patient survival, or wound or urologic complications between groups (p > 0.05). CONCLUSIONS: The elimination of warm ischemic time using the IBT does not appear to reduce the incidence or length of DGF in this cohort. The technique may be useful for cases with prolonged anastomosis time (AT), but further studies with larger cohorts are required to determine whether it decreases DGF.

No benefit when placing drains after kidney transplant: a complex statistical analysis.

OBJECTIVES: This paper sought to determine if there were an association between drain placement and the incidence of wound complications. MATERIALS AND METHODS: A single-center institutional review board-approved retrospective study between 2001 to 2008, comparing 680 kidney transplant patients who either had a drain placed or were left undrained. Linear regression modeling was used to adjust the risk factors between the groups. Patients received calcineurin inhibitors, steroids, and a mycophenolate formulation. The incidence of early major and minor wound complications were captured. Minor wound complications were defined as seroma, lymphocele, and perigraft fluid collection, and major wound complications were defined as wound dehiscence, hematomas, evisceration, infections, wound necrosis, and hernias. Patients with incomplete data or those taking sirolimus were excluded. RESULTS: Six hundred eighty kidney transplant cases were reviewed. Four hundred seventy-nine received drains; 201 did not. Demographic analyses revealed that the drain group had a higher average value in age and body mass index. The drain group had a lower albumin and a lower mean platelet count after surgery. The number of patients without diabetes in the drain group numbered nearly twice as many as did those without drains. An attempt was made to statistically account for demographic differences. Seventy-eight of 479 drained patients (16.28%) and 24 of 201 no-drain patients (11.94%) had a wound complication. Minor wound complications were observed in 9 patients (1.88%) in the drain group and 6 in no-drain group (2.99%) (P = .3702). Major wound complications were observed in 58 patients in the drain group (12.18%) and 17 in the no-drain group (8.46%) (P = .1655). Drain placement had no effect on major or minor wound complications. CONCLUSIONS: Drain placement is not associated with major or minor wound complications in kidney transplants.

Satisfactory outcomes with usage of extended criteria donor (ECD) kidneys in re-transplant recipients.

BACKGROUND: The use of extended criteria donor (ECD) kidneys have increased substantially and the benefit recognized in certain populations. Our institution has maintained a policy of aggressively utilizing ECD kidneys, even among those who have failed a previous transplant. Previous reports on the benefit of ECD in re-transplants have shown equivocal outcomes. We sought to determine if our experience would support or refute this finding. MATERIAL AND METHODS: This is a retrospective study of 19 ECD re-transplants between 2002 and 2010. We compared 1 and 3 year outcomes with 95 patients with standard criteria donor (SCD) re-transplant and 169 patients with first time transplant using ECD kidneys. Outcomes and demographics were evaluated including delayed graft function (DGF), HTN, DM, cold ischemia time (CIT), BMI, donor age and prior allograft nephrectomies using a Cox Proportional Hazard model. We compared patient and graft survival using the log rank test. RESULTS: Patient survival were similar among the first time ECD and ECD re-transplant groups at 1 year (p=0.9547) and at 3 years (p=0.8287). Graft survival was also similar between first time ECD and ECD re-transplant groups at 1 year (p=0.4781) and at 3 years (p=0.8519). As expected, SCD re-transplant had better outcomes than the other groups. CONCLUSIONS: 1 and 3 years graft and patient survival among first time ECD transplants and ECD re-transplants are similar. As the list of patients on dialysis is ever growing, it may be prudent to aggressively explore the utility of using ECD kidneys in re-transplant patients.