Incidence, risk factors, and outcomes of delayed graft function in deceased donor kidney transplantation in a Brazilian center.

BACKGROUND: A high incidence of delayed graft function (DGF) after deceased donor kidney transplantation occurs in Brazil. The reasons for such have not been adequately studied. METHODS: We performed a retrospective cohort study of 346 kidney transplant recipients from deceased donors. DGF risk factors related to the recipient, donor, and transplantation surgery were analyzed and correlated with graft outcomes. A logistic regression analysis was used to identify independent risk factors and patient and graft survival were assessed using Kaplan-Meier curves. RESULTS: The incidence of DGF was 70.8% (245 cases). Our final model of multivariate analysis showed that DGF is associated (P < .05) with donor final serum creatinine (relative risk [RR], 1.84; 95% confidence interval [CI], 1.26-2.70), donor age (RR, 1.02 [1.0-1.033]), receiving a kidney from national offer (RR, 2.44 [1.06-5.59]), and need for antibody induction (RR, 2.87 [1.33-6.18]). Outcomes that were associated with DGF were longer length of hospital stay (32.5 ± 20.5 vs 18.8 ± 16.3 days; P = .01), higher incidence of acute rejection (37.8 vs 12.9%; P < .01), worse graft survival at 1 year (83.5% vs 93.9%; P < .01), and higher levels of serum creatinine at 3, 6, and 12 months (P < .05). There was no difference in patient survival and the occurrence of acute rejection did not influence the survival of patients or grafts. CONCLUSION: DGF was associated with higher donor final serum creatinine, donor age, receiving a kidney from the national supply, and need for antibody induction. Most importantly, DGF was associated with worse outcomes.

Evaluation of adherence to immunosuppressive drugs in kidney transplantation by control of medication dispensing.

Nonadherence to immunosuppressive medications represents a burden to organ transplantation being associated with rejection episodes and graft loss. In this cross-sectional study we evaluated the prevalence and risk factors for nonadherence in kidney transplant patients by measuring the retrieval of the immunosuppressive drugs in the registry kept by the state Rio Grande do Sul public health system. We considered nonadherence the failure to retrieval of medication at least one time over a 1-year period of evaluation. In 288 patients evaluated, the frequency of failure to retrieve was 58.7%. Being fully employed (66.4% × 33.6%, P = .008) and younger age at transplantation (39 ± 13 × 46 ± 11, P = .011) were associated with nonadherence. Multivariate analysis showed a greater prevalence ratio (PR) of non- adherence in patients using tacrolimus. Estimated glomerular filtration rate was significantly lower in the nonadherence groups as compared with adherent groups (45.3 ± 21.6 × 51.3 ± 19.4, P = .016). In conclusion, we found a high prevalence of nonadherence to immunosuppressive drugs with association to active working situation and use of tacrolimus. Importantly, glomerular filtration rate was found to be lower in nonadherent patients.

Evaluation of apoptosis in peripheral blood lymphocytes of renal transplant patients.

The aim of this study was to evaluate the occurrence of apoptosis and the expression of FasL and IL-2 genes in apoptotic peripheral blood mononuclear cells (PBMC) at different posttransplant periods. Three groups of patients were studied: group 1, kidney transplant recipients at least 1 year posttransplant (n = 17); group 2, kidney transplant recipients at least 5 years posttransplant (n = 15); and a control group composed of 7 healthy subjects. Apoptosis was detected by annexin flow cytometry and gene expression by reverse transcription polymerase chain reactions. The percentage of apoptotic cells was significantly higher in groups 1 (42 +/- 4%) and 2 (37 +/- 3%) than the controls (27 +/- 2%; P < .0001). Apoptotic cells in group 1 was significantly higher than in group 2 (P < .005). A significant difference in FasL expression was observed between groups 1 and 2 (P < .001) and the immunosuppressive regimen. These findings suggest that PBMC of kidney transplant recipients are more susceptible to activation-induced cell death and that the Fas-FasL pathway is involved in this process.

Monitorizaçäo seqüencial do transplante renal com citologia aspirativa / Sequential monitoring of renal transplant with aspiration cytology

Objetivo. Avaliar a utilidade da citologia aspirativa renal convencional na monitorizaçao seqüencial da rejeiçao aguda de transplantes renais. Material e Método. 376 punçoes aspirativas renais em 30 pacientes transplantados. Os diagnósticos das situaçoes clínicas em que as aspiraçoes foram feitas foram estabelecidos de maneira independente. Resultados. Na avaliaçao seqüencial "cega" obteve-se 82,7 por cento de representatividade das amostras. Encontraram-se aumentos significativos do incremento corrigido total (ICT) e dos números de células imunoativas por lâminas nos episódios de rejeiçao aguda quando comparados aos valores obtidos durante os períodos de funçao estável do enxerto, necrose tubular aguda e nefrotoxicidade por ciclosporina. Os parâmetros diagnósticos para rejeiçao aguda foram: sensibilidade: 71,8 por cento; especificidade: 87,3 por cento; valor preditivo positivo: 50,9 por cento; valor preditivo negativo: 94,4 por cento; e acurácia: 84,9 por cento. Os resultados falsos-positivos para rejeiçao foram devidos, principalmente, a infecçao citomegálica ou subseqüentes ao uso de OKT3 para tratamento de episódios de rejeiçao aguda celular. Em 10 dos 11 resultados falsos-negativos, encontrou-se o diagnóstico de imunoativaçao incipiente, que deve ser considerado como um alerta para a possibilidade de rejeiçao aguda. Conclusoes. A citologia aspirativa renal é um método útil na monitorizaçao seqüencial da rejeiçao aguda no paciente transplantado renal. Os melhores resultados sao obtidos quando os dados da citologia aspirativa sao interpretados juntamente com o quadro clínico.