Living Kidney Donor Cancellation at King Hussein Medical Center.

OBJECTIVES: Living-related kidney donation is the main source of renal grafts in Jordan, since kidneys from deceased donors are scarce. Although the Jordanian community accepts the idea of kidney donation to family members, not all potential donors manage to complete the required psychologic and medical evaluations. We review the causes of kidney-donation cancellation and suggest options to increase the number of available organs. MATERIALS AND METHODS: We performed a retrospective chart review of all potential living-related kidney donors at King Hussein Medical Center between January 2008 and June 2016. RESULTS: Of 642 potential donors, 366 (57%) were male and 276 (43%) were female, ranging in age from 18 to 66 years with a mean age of 37 years. A total of 384 (59.8%) eventually donated a kidney. A donor issue was the cause of cancellation in 143 (22.3%), whereas 47 (32.9%) had a risk for renal impairment after donation (eg, hematuria, proteinuria, stones, multiple renal cysts, scarred kidney, congenital malformation, recurrent urinary tract infection), and 30 (21%) had blood group or immunologic incompatibilities. Fifteen (10.5%) withdrew during the evaluation process, 13 (9%) had hypertension, 10 (7%) had a high body mass index, 8 (5.6%) were diabetic or prediabetic, 7 (4.9%) were surgically unsuitable, 4 (2.8%) had hepatitis B virus infection, 4 (2.8%) were pregnant, 3 (2.1%) had significant cardiovascular disease, 1 (0.7%) had splenomegaly with lymph node enlargement, and 1 (0.7%) had thyroiditis. CONCLUSIONS: Cancellation of kidney donation in Jordan is mainly for medical reasons, the most common being renal issues. Paired donation between blood group and immunologically incompatible duos may increase the number of organs available, as may good psychologic assessment and counseling of those likely to change their mind. Support should be provided for donors who drop out of donation for any cause, especially for renal and vascular issues.

Renal Impairment and Complication After Kidney Transplant at Queen Rania Abdulla Children's Hospital.

OBJECTIVES: Kidney transplant is the treatment of choice for end-stage renal disease, but it is not without complications. We review the medical cause of significant renal impairment and complications that developed after kidney transplant in pediatric patients who required hospital admission and intervention and/or who were followed between 2007 and 2016. MATERIALS AND METHODS: A retrospective noninterventional chart review study was conducted in pediatric patients who received a kidney transplant and/or followed at the nephrology clinic at Queen Rania Abdulla Children's Hospital between 2007 and 2016. RESULTS: In this study, 101 pediatric patients received a total of 103 transplants. Forty-eight patients (47%) experienced deterioration of kidney function out of a total of 53 episodes of complications; 37 of these episodes occurred early (0-6 mo after transplant), and 26 episodes occurred late. The causes of kidney function deterioration were surgical complications, acute tubular necrosis, cell- or antibody-mediated rejection, diabetes mellitus, urinary leak, recurrence of original disease, and chronic allograft nephropathy. Thirteen patients experienced graft loss; 50% of these losses were secondary to noncompliance to immunosuppressant medication treatment after transplant. A total of six patients died; 2 (23%) of these deaths occurred in the first week after transplant, whereas the other 4 patients died over a period of 10 years. CONCLUSIONS: Pediatric kidney transplant is not without complications; however, most of these complications are treatable and reversible. The most serious complications leading to graft loss and death occur early, in the first week after transplant. Improving immunosuppressant compliance after transplant would prevent 50% of graft losses.

The impact of CYP3A5 and MDR1 polymorphisms on tacrolimus dosage requirements and trough concentrations in pediatric renal transplant recipients.

Previous international studies demonstrated significant heterogeneity in the tacrolimus (TAC) dose required to attain target blood concentrations, attributed to both genetic and ethnic factors. While the majority of previous reports on adult recipients of renal, heart and liver transplants have shown a significant effect of CYP3A5FNx013 single nucleotide polymorphisms (SNPs) on TAC pharmacokinetics (PKs), the impact of multidrug resistance protein 1 (MDR1) and SNPs remains controversial. Yet, similar data of TAC in pediatric populations, in whom the intra- and inter-subject variations are likely to be even greater, is currently limited. We aimed to examine the influence of various CYP3A5 and MDR1 genotypes on TAC dose requirements and PKs in the Jordanian pediatric renal transplant population. Thirty-eight patients were genotyped for CYP3A5FNx011 and FNx013 and MDR1 C3435T. Dose-adjusted trough concentrations (C 0 /D) and daily doses (D) were compared among different CYP3A5 and MDR1 genotypes in the early and maintenance phases post-transplant. Surprisingly, there were no significant differences in D, C 0 or C 0 /D among the genotypes of CYP3A5 or MDR1 polymorphisms in either the early or the maintenance phase after transplantation, whereas after combining the C 0 /D levels of MDR1 C allele expressers, noticeably lower TAC levels were observed as compared with the TT genotype. However, the difference became not significant beyond 3 months. Based on a pharmacogenetic evaluation, the independent impact of CYP3A5 SNPs on TAC PKs was not evident, demonstrating the need for further large-scale studies.