Kidney Transplantation in Old Recipients From Old Donors: A Single-Center Experience.

PURPOSE: The program Old for Old or European Senior Program (ESP), allocates donors aged ≥65 years to recipients of ≥65, within a narrow geographic area in order to minimize cold ischemia time, decrease the waiting time for elderly patients listed for kidney transplantation and expand the transplant resource in this group. The ESP is not officially applied in Greece. In our center, the Old for Old criteria have been used since 2003 for elderly patients who are candidates for kidney transplantation. METHODS: We aimed to retrospectively evaluate the results of kidney transplantation from donors ≥65 years to recipients ≥65 years (Old for Old group), by examining a 5-year actual survival of the recipient and the graft. Ten Old for Old transplantations were performed at our center and the graft and patient survival was estimated during a 5-year follow-up. This group was compared to a control group of 10 recipients under the age of 65, who received grafts from deceased donors aged ≥65 years; it was found that graft and patient survival was significantly lower in the Old for Old group (50% and 58% respectively), compared to the control group, with graft and patient survival 72% and 80%, respectively (P < .05). The main cause of death was cardiovascular disease. CONCLUSIONS: More studies with higher number of patients are needed for the assessment of survival outcome between the elderly transplanted patient and those on dialysis listed for renal allografts to conclude whether Old for Old transplantation is beneficial. It is also important to consider a better pre-transplant medical evaluation with attention to cardiovascular status of the candidates and modification of the immunosuppression protocol in order to avoid serious infections and long hospital stays.

Fulminant Epstein-Barr virus-associated hemophagocytic syndrome in a renal transplant patient and review of the literature.

We describe a rare fulminant case of Epstein-Barr virus-associated hemophagocytic syndrome (HPS) in a 37-year-old female renal transplant patient, indistinguishable from severe sepsis clinically and in the laboratory. HPS involves rapidly escalating immune system activation, resulting in a cytokine cascade, which can, especially in immunocompromised patients, lead to multi-organ failure, and even death. Thirty-two Herpesviridae-associated HPS cases in renal transplant patients have been reported and are reviewed. Overall mortality is 47% (15/32 cases).

Secondary hyperparathyroidism and target organs in chronic kidney disease.

Secondary hyperparathyroidism (SHPT) is a common disorder in patients with chronic kidney disease (CKD) and is characterized by excessive serum parathyroid hormone (PTH) levels, parathyroid hyperplasia and an imbalance in calcium and phosphorus metabolism. Secondary hyperparathyroidism develops early in the course of CKD and becomes more prominent as kidney function declines.PTH is a major uremic toxin and may be responsible for long-term consequences that include renal osteodystrophy, severe vascular calcifications, alterations in cardiovascular structure and function, immune dysfunction, and anemia. These adverse effects may contribute to an increased risk of cardiovascular morbidity and mortality among end-stage renal failure patients.

Outcomes of kidney transplantation in Greek and Albanian patients: a single centre experience.

BACKGROUND AND AIM: It has been reported that racial and ethnic (genetic make up), as well as socioeconomic differences may affect the results of kidney transplantation. Socioeconomic factors are quite difficult to differentiate from genetic factors. It is not surprising that a group with poorer access to health care, less private insurance and less income does less well with serious medical problems. The aim of this study was to compare the outcomes of kidney transplantations in Greek (G) and Albanian (A) patients. PATIENTS AND METHODS: Twenty nine transplanted patients of Albanian ancestry were matched with 29 Greek patients retrospectively. Their mean age was 34 (G) and 31 (A) years, there were 21 men and 8 women in each group (G, A) and they received 26 kidneys from living related donors and 3 kidneys from cadaveric donors respectively. Arterial blood pressure (ABP), body weight (BW), serum creatinine, serum total protein and albumin, total cholesterol, HDL-cholesterol and triglycerides, 24 hour proteinuria were measured on 7th, 15th postoperative day, 1st , 3rd , 6th month and 1st year after transplant. BMI was calculated before and 1 year after transplantation and acute rejection episodes were recorded too. Methylprednizolone (MP), cyclosporine (CsA) dose /kg BW were calculated at baseline, 1, 3, 6, 12 months after transplant. Cumulative patient and graft survival at 1 and 5 years were calculated too. RESULTS: Patient survival at 1 and 5 years was 100% / 93.1% and 100% /93.1% respectively (p: NS). Graft survival at 1 and 5 years was 100% / 93.10% and 93.75% / 86.45% respectively (p: NS). BW (but not BMI) and total cholesterol levels in Greek patients were higher compared to those of Albanian patients during the 1st post transplant year (p: 0.044 and p: 0.021 respectively). MP dose in A patients was higher during the first year (p: 0.05). CONCLUSION: Patients and graft survival do not present difference between G and A patients. There is significant difference on cholesterol profile between G and A patients. A larger number of transplants are possibly needed to allow us to draw firm conclusions.