Randomized Trial of Machine Perfusion Versus Cold Storage in Recipients of Deceased Donor Kidney Transplants With High Incidence of Delayed Graft Function

BACKGROUND: This study compared the use of static cold storage versus continuous hypothermic machine perfusion in a cohort of kidney transplant recipients at high risk for delayed graft function (DGF). METHODS: In this national, multicenter, and controlled trial, 80 pairs of kidneys recovered from brain-dead deceased donors were randomized to cold storage or machine perfusion, transplanted, and followed up for 12 months. The primary endpoint was the incidence of DGF. Secondary endpoints included the duration of DGF, hospital stay, primary nonfunction, estimated glomerular filtration rate, acute rejection, and allograft and patient survivals. RESULTS: Mean cold ischemia time was high but not different between the 2 groups (25.6 ± 6.6 hours vs 25.05 ± 6.3 hours, 0.937). The incidence of DGF was lower in the machine perfusion compared with cold storage group (61% vs. 45%, P = 0.031). Machine perfusion was independently associated with a reduced risk of DGF (odds ratio, 0.49; 95% confidence interval, 0.26-0.95). Mean estimated glomerular filtration rate tended to be higher at day 28 (40.6 ± 19.9 mL/min per 1.73 m2 vs 49.0 ± 26.9 mL/min per 1.73 m2; P = 0.262) and 1 year (48.3 ± 19.8 mL/min per 1.73 m2 vs 54.4 ± 28.6 mL/min per 1.73 m2; P = 0.201) in the machine perfusion group. No differences in the incidence of acute rejection, primary nonfunction (0% vs 2.5%), graft loss (7.5% vs 10%), or death (8.8% vs 6.3%) were observed...

Fatores de risco cardiovascular em pacientes pediátricos após um ano de transplante renal / Cardiovascular risk factors in pediatric patients after one year of renal transplant / Factores de riesgo cardiovascular en pacientes pediátricos después de un año de trasplante renal

Objetivo: Identificar a frequência de diabetes mellitus e a presença de fatores de risco cardiovascular em pacientes pediátricos após um ano de transplante renal. Métodos: Estudo retrospectivo, de cunho documental e exploratório, realizado de janeiro de 2000 a janeiro de 2006, abrangendo 111 prontuários de pacientes pediátricos (0 a 18 anos incompletos) submetidos a transplante renal no Hospital do Rim e Hipertensão e no Hospital São Paulo da Universidade Federal de São Paulo. Resultados: Foram analisados 111 pacientes, 50,5 por cento utilizavam anti-hipertensivos antes do transplante renal. Um ano após este número caiu para 28 por cento. No pré-transplante 13,5 por cento pacientes apresentaram sobrepeso e após um ano não houve alteração importante (12,6 por cento). O número de pacientes obesos aumentou 50 por cento após um ano de transplante renal. Aproximadamente 1 por cento das crianças desenvolveram diabetes mellitus pós-tranplante renal. Conclusão: A presença de excesso de peso (sobrepeso e obesidade), hipertensão arterial e diabetes mellitus são freqüentes em pacientes pediátricos pós-tranplante renal.

Objective: To identify the prevalence of diabetes mellitus and the presence of cardiovascular risk factors in pediatric patients after one year of renal transplant. Methods: This was an exploratory retrospective study. Data were collected from 111 medical records of pediatric patients (aged 0 to incomplete 18 year old) who underwent renal transplant at both the "Hospital do Rim and Hypertension (Renal and High Blood Pressure Hospital) and the São Paulo Hospital of the Federal University of São Paulo between January 2000 and January 2006. RESULTS: A half of patients (50.5 percent) used high blood pressure medications prior to undergoing renal transplant. A year after renal transplant the use of high blood pressure medications by the pediatric patients was reduced by 28 percent. Before transplant, 13.5 percent of the patients were overweighed and did not have any significant changes in their weight after the transplant (12.6 percent). There was an increase in the number of overweight patients after a year of renal transplant by 50.0 percent. Approximately 1.0 percent of the patients developed diabetes mellitus after the renal transplant. Conclusion: Obesity, high blood pressure, and diabetes mellitus were common conditions among pediatric patients after renal transplant.

Objetivo: Identificar la frecuencia de diabetes mellitus y la presencia de factores de riesgo cardiovascular en pacientes pediátricos después de un año de trasplante renal. Métodos: Estudio retrospectivo, de orden documental y exploratorio, realizado de enero de 2000 a enero de 2006, abarcando 111 fichas de pacientes pediátricos (0 a 18 años incompletos) sometidos a trasplante renal en el Hospital del Riñón e Hipertensión y en el Hospital Sao Paulo de la Universidad Federal de Sao Paulo. Resultados: Fueron analizados 111 pacientes, 50,5 por ciento utilizaban anti-hipertensores antes del trasplante renal. Un año después este número cayó para 28 por ciento. En el pre-trasplante, 13,5 por ciento pacientes presentaron sobrepeso y después de un año no hubo alteración importante (12,6 por ciento). El número de pacientes obesos aumentó 50 por ciento después de un año de trasplante renal. Aproximadamente 1 por ciento de los niños desarrollaron diabetes mellitus después del trasplante renal. Conclusión: La presencia de exceso de peso (sobrepeso y obesidad), hipertensión arterial y diabetes mellitus son frecuentes en pacientes pediátricos después del trasplante renal.