Long-Term (≥25 Years) Kidney Allograft Survivors: Retrospective Analysis at a Single Center.

INTRODUCTION: Despite great improvements in the short-term patient and kidney graft survival, the long-term morbidity and mortality in kidney transplant recipients still remains a significant problem. The aim of the study was to evaluate the impact of both donor and transplant recipient factors, as well as renal function indices on the very long-term (>25 years) kidney allograft survival. MATERIAL AND METHODS: Retrospective analysis was performed on the data of 41 kidney transplant recipients (KTR), group A: follow-up = 25 years, 20 KTR, 10 male, mean age (mean [M] ± standard deviation [SD]): 34.6 ± 12.6 years, 14 living donors (LD), 6 cadaveric donors (CD); group B: follow-up > 25 years, 21 KTR, 16 male, mean age (M ± SD): 30.86 ± 12.37 years, 14 LD, 7 CD). Kidney graft origin, post-kidney transplantation diabetes mellitus, HLA compatibility, delayed graft function, and acute rejection episodes were also analyzed retrospectively. Statistical analysis with Mann-Whitney test and Kaplan-Meier survival analysis was performed (SPSS 20.0 for Windows). RESULTS: The mean age of CDs was lower than that of LDs: CD mean age (M ± SD): 23.84 ± 16.26 years vs LD mean age: 52.75 ± 12.42 years (P < .001). Cadaveric kidney graft was associated with better renal allograft function 10, 15, and 25 years post kidney transplant. None of the other factors analyzed reached statistical significance between the 2 groups. CONCLUSION: The age of the donor and the kidney graft origin are important co-factors of the very long-term kidney allograft survival.

New-Onset Diabetes After Transplantation: Comparison Between a Cyclosporine-Based and a Tacrolimus-Based Immunosuppressive Regimen.

INTRODUCTION: New-onset diabetes after transplantation (NODAT) is a complication of renal transplantation (RT) with an adverse effect on graft survival. OBJECTIVES: The purpose of the present study was to compare modifiable or non-modifiable clinical and laboratory parameters as well as the course of patients and transplants between 2 groups of RT recipients with NODAT in relation to the use of either a cyclosporine-based (group A) or a tacrolimus-based immunosuppressive regimen (group B). MATERIALS AND METHODS: Retrospectively comparing 66 renal transplant recipients with NODAT, multiple clinical, and laboratory parameters were investigated. For statistical analysis, the χ2 test, the Student t test, and the patient and graft survival or the Kaplan-Meier analysis from the statistical software SPSS 22.0 for Windows were used. RESULTS: There was no statistically significant difference in association with the majority of the investigated parameters. In group B (tacrolimus [Tac]), more patients had HbA1c >7.2% at 3 years after RT. The mean value of systolic blood pressure was higher in group A (cyclosporine [CsA]) at 6 months and at 1 year after RT. More patients in group A (CsA) experienced at least one acute rejection episode. Finally, greater levels of cold ischemia time were recorded in group B (Tac) and statistically significant difference was found in connection with the patient and graft survival in the fourth year after RT. CONCLUSIONS: NODAT in patients on tacrolimus requires the adjustment of modifiable clinical and metabolic parameters and possible change of the immunosuppressive regimen to a cyclosporine-based one.

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).

Simultaneous pancreas-kidney transplantation: initial results from a center in Greece.

AIM: The outcome of simultaneous pancreas-kidney transplantation (SPK) in type 1 diabetes has dramatically improved in recent years. We report the initial results of our SPK program. PATIENTS AND METHODS: From 2008 to 2010, we performed and prospectively obtained data on 4 SPKs in 4 type 1 diabetic patients with chronic renal failure. The recipients were 3 men and 1 woman, of overall mean age of 40.75 ± 4.78 years, mean time from diabetes diagnosis of 27 ± 15 years, and time on dialysis of 3.5 ± 0.57 years. All grafts were procured from multiorgan brain-dead donors of mean age 26 ± 8.16 years and mean body weight of 74 ± 4.34 kg. The pancreatic grafts were transplanted first into the right iliac fossa with mean cold ischemia times of 10.62 ± 3.09 hours for the pancreatic and 14.00 ± 2.97 hours for the renal grafts. Pancreas arterial inflow was re-established by an end-to-side anastomosis of an extension Y-graft to the recipient right iliac artery. The portal vein was sutured to the iliac vein directly. The exocrine secretions of the pancreas were managed by duodenojejunostomy extraperitoneally (n = 3) or intraperitoneally (n = 1). The ureteral anastomosis was performed using the Taguchi technique. RESULTS: After SPK, endocrine pancreatic function was immediately restored in all patients. Insulin administration was stopped within the first 24 hours after surgery. Two patients displayed delayed renal graft function necessitating dialysis for 9 and 23 days, respectively. The postoperative course was prolonged with a mean hospital stay of 82 ± 1 day. At a 31.75 ± 9.03 months follow up all patients are alive with functioning grafts. CONCLUSION: Our experience with SPK, although limited, has shown encouraging results over a short follow-up period.

Prevalence and clinical impact of cytomegalovirus infection and disease in renal transplantation: ten years of experience in a single center.

INTRODUCTION: Renal transplantation is regarded as the optimal treatment for patients with end-stage renal disease. Despite significant improvements in surgical techniques and immunosuppressive therapy, long-term graft survival has not markedly increased over the years, due in part to the occurrence of cytomegalovirus (CMV) infection. PATIENTS AND METHODS: Between January 2001 and September 2011, we performed 592 kidney transplantations (214 living and 378 cadaveric donors). All patients received induction therapy with interleukin (IL)-2 monoclonal antibodies or antithymoglobulin (ATG) combined with calcineurin inhibitors, mycophenolate mofetil, or mTOR antagonists and steroids. All CMV-seronegative patients and all subjects receiving ATG induction were prescribed prophylactic therapy with ganciclovir-intravenous (IV) for 15 days 2.5 mg/kg BW bid and thereafter oral valgancyclovir once a day. CMV infection was diagnosed using a CMV-PVR of ≥ 600 copies. We analyzed the time to manifestations of CMV infection, or positive CMV-PCR, patient and graft survival, serum creatinine (Cr), and blood urea nitrogen (BUN) values before and after CMV infection, as well as type of immunosuppression therapy. RESULTS: The overall incidences of CMV infection and CMV disease were 76/592 (12.8%) and 23/592 (3.9%), respectively. The mean ± standard deviation (SD) times to positive CMV-PCR and CMV disease were 16.66 ± 23.38 months and 106 ± 61.2 (range, 28-215) days, respectively. Mortality was 1% (6/592) among our whole population, 7.9% (6/76) for CMV-infected, and 26% (6/23) in the CMV disease cohort. Cr and BUN showed no significant differences among the groups. CONCLUSIONS: CMV infection and CMV disease comprise significant clinical problems, increasing morbidity and mortality. The use of prophylactic anti-CMV treatment is of paramount importance.

Use of everolimus in de novo renal recipients: initial experience in the Greek population.

Although everolimus has proven to be as clinically efficacious as mycophenolate mofetil (MMF), there are reports that proliferation signal inhibitors are associated with poor tolerability. This study reported the experience of a Greek transplant center using either everolimus or MMF in de novo renal transplant recipients. In this retrospective study, a cohort of 40 patients who received everolimus after renal transplant was matched for 10 descriptive parameters with a cohort of another 40 patients who received MMF. The primary endpoint was renal function measured by creatinine and its clearance as well as wound dehiscence and opportunistic infections. The mean creatinine clearance at month 3 was 61.03 +/- 16.99 mL/min versus 60.99 +/- 8.03 for living related recipients on everolimus versus MMF, respectively. The mean creatinine clearance at month 3 was 71.24 +/- 12.61 and 62.61 +/- 20.24 mL/min for cadaveric recipients on everolimus versus MMF, respectively. In addition, the incidence of wound dehiscence was 33.34% versus 3.92% and the incidence of cytomegalovirus infection, 8.33% versus 17.64% for the same two groups, respectively.

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.

Combined treatment of hypercholesterolemia of renal transplant allograft recipients with fluvastatin and gemfibrozil.

The aim of this study was to investigate the safety and efficacy of combined treatment with fluvastatin (F) and gemfibrozil (G) in hypercholesterolemic renal transplant recipients (RTR). Ten hypercholesterolemic (total cholesterol [TC] > 220 mg/dl) RTR (7 men) with mean age 44 years (range 25-56 years) who remained hypercholesterolemic after 3 months of treatment (period A) with fluvastatin (40 mg/d) continued taking the same dose of F plus G (600 mg/dl) for another 3-month period (B). Serum total cholesterol, high density lipoprotein cholesterol (HDL-C), LDL cholesterol (LDL-C), triglyceride, serum creatinine (creatinine phosphokinase (CPK), serum glutamic-oxaloacetic transaminase (SGOT), and serum glutamate pyruvate transaminase (SGPT) were measured before treatment and at the end of periods A and B. Mean TC levels were 360.30 +/- 62.42 mg/dl, 324.10 +/- 100.53 mg/dl, 270.80 +/- 67.77 mg/dl; mean LDL-C levels were 259.33 +/- 71.43 mg/dl, 219.60 +/- 81.31 mg/dl, 189.70 +/- 65.51 mg/dl; mean HDL-C levels were 37.10 +/- 11.68 mg/dl, 39.80 +/- 13.21 mg/dl, 41.00 +/- 12.94 mg/dl; mean triglyceride levels were 354.60 +/- 183.29 mg/dl, 349.30 +/- 242.94 mg/dl, 207.00 +/- 85.35 mg/dl before treatment and at the end of periods A and B, respectively. There was a statistically significant fall of serum TC (P = 0.002), LDL-C (P = 0.016), and triglyceride (P = 0.029) levels at the end of periods A and B. Kidney and liver function did not change. F and G combined treatment is safe and useful in patients who do not respond satisfactorily to monotherapy with F. Gemfibrozil augments the effect of F on TC, LDL-C, and triglyceride levels.