Anatomical Variants in Renal Transplantation, Surgical Management, and Impact on Graft Functionality.

INTRODUCTION: Chronic kidney disease (CKD) is a priority problem due to its high prevalence. According to the modalities of renal replacement therapy, kidney transplantation (TR) offers to be the best alternative. TR presents multiple factors of dependence of success; among them is the management of the anatomical variants of the graft and the surgical decision on the basis of these. Therefore, the objective of this study is to determine the frequency of variants in the graft, its surgical management, and the impact on the functionality of the transplanted kidney. MATERIAL AND METHODS: This was an observational, retrospective study of patients in the renal transplant unit of the Siglo XXI National Medical Center from 2002-2016. The analysis begins in the description of the population doing bivariate analysis to establish relative risks. For variables with a central tendency, the parametric tests analysis of variance, Student t paired, and unpaired will be used. In the case of nominal variables, the proportion's difference will be estimated using the chi-square test, establishing significance when P is ≤ .05. SPSS 21 software was used. RESULTS: There were a total of 773 patients, with 576 transplants from living donors and 197 from deceased donors. In the case of the artery, a greater number of variants is observed-27.8% being alive versus 17.3% of the variants found in deceased donors. For the renal vein, 12.7% of the kidneys were taken from living donor vs 6.1% from deceased donors. This required one more day of hospitalization (6 vs 7 days of single vs multiple vessels); likewise, increases in immediate post-transplant infections were 5% for single vessels vs 8% in the case of multiple variants. CONCLUSIONS: The importance of knowing the anatomical variants prior to the TR allows them to plan the potential surgical maneuvers, decreasing the times aimed at improving the immediate functionality of the renal graft, while also considering the increase in hospital expenses due to the greater number of days of hospitalization.

Specific Antigens by Federal Entity in Patients at the Transplant Unit of Specialities Hospital, National Medical Center Twenty-First Century, Mexico.

BACKGROUND: The study of the kidney transplant involves understanding the immunologic basis, such as histocompatibility and the genetic basis of a population. In Mexico, the study of the genetic basis has led to a genetic map by federal entities. METHODS: We performed an HLA study with 1,276 kidney transplant patients (recipients and donors) in the Hospital of the National Medical Center Twenty-First Century, determining HLA class I (A, B, and Cw) and class II (DRß1 and DQß1) antigens with the use of SSOP-PCR. A descriptive analysis was conducted with measures of central tendency (mean, SD). RESULTS: Of 1,276 HLA patients studied, we obtained 2,552 results for each class by the composition of the 2 haplotypes, and for HLA-Cw we processed 796 patients, for a total of 1,592 antigens for this class. We found antigens specific to each federal entity, and it was found that the Federal District had the highest number of specific antigens (10) followed by Morelos (7), Querétaro and Mexico State (3 each), and Tamaulipas, Aguascalientes, Michoacán, Guerrero, Puebla, and Oaxaca (1 each). CONCLUSIONS: The genetic map allows us to know proportions of antigens in every state in the center and south of Mexico owing to the diversity and area of influence of the National Medical Center XXIst Century, as well as the wide number of patients. Furthermore, there are still preserved proportionally distinct genetic roots in every entity.

The Most Common HLA Antigens Found in Patients With Renal Transplants at the Specialties Hospital of "La Raza" Medical Center, Mexico.

BACKGROUND: The knowledge to understand transplant acceptance or rejection derives directly from knowing its genetic material and the major histocompatibility complex involved in immune response, so it is essential to identify the most common alleles in the Mexican population. METHODS: In the northern areas of the Federal District (DF), Hidalgo, and Mexico State, we performed an analysis of HLA class I (A and B) and HLA class II (DRß1 and DQß1) with the use of the PCR-SSP process (Invitrogen). We performed measures of central tendency and percentages of common alleles in the study population. RESULTS: We analyzed 718 results of patients before renal transplantation: 313 pairs of recipients and living donors and 92 patients receiving cadaveric donation. HLA allele A 02 536 (37.32%) was the most common allele found. In HLA B, the most common allele corresponded to 35, in 321 (22.35%), which was the most polymorphic. In HLA DRß1 the most common was 04, in 447 (31.12%), which was the least polymorphic; the most common was 03, in 777 (54.10%). CONCLUSIONS: We corroborated the frequency of alleles found in the considered population, which corresponds to the northern part of Mexico City as well as the states of Mexico and Hidalgo. It was determined that there is no risk allele for developing chronic kidney disease.