Factors Associated With Delayed Graft Function and Their Influence on Outcomes of Kidney Transplantation.

BACKGROUND: One of the main postoperative complications of kidney transplant is delayed graft function (DGF), which means absence of graft function after transplant or the need for dialysis during the first week post procedure. The occurrence of DGF currently in our hospital is high and has been attributed to a combination of many factors. The aim of this study was to evaluate the factors associated to DGF and their influence in the outcome of kidney transplants. METHODS: Historical cohort of 150 patients transplanted with live or deceased donor kidneys from 2011 to 2013. RESULTS: DGF was associated to time in dialysis and the number of recipient pre-transplant transfusions, donors age, serum creatinine level, use of vasoactive drugs in the donor, distance from place of organ retrieval and transplant center, and duration of cold ischemia time. DGF influenced post-transplantation outcome in regard to length of stay in intensive care, length of hospital stay, acute rejection episodes, and higher creatinine levels at discharge. Patients and graft survival were shorter in the DGF group. CONCLUSIONS: There are multiple factors related to DGF, the most important being those related to donors, and organ storage. The most important factor related to the recipient was the dialysis vintage. We did not find a correlation between DGF and HLA-compatibility. DGF consequences are important, including worse graft function and survival, as well as impact in recipient morbidity and mortality.

Systemic lupus erythematous and clinical outcomes in peritoneal dialysis.

BACKGROUND: The prevalence of systemic lupus erythematous (SLE) patients requiring renal replacement therapy (RRT) is increasing but data on clinical outcomes are scarce. Interestingly, data on technique failure and peritoneal-dialysis (PD)-related infections are rarer, despite SLE patients being considered at high risk for infections. The aim of our study is to compare clinical outcomes of SLE patients on PD in a large PD cohort. METHODS: We conducted a nationwide prospective observational study from the BRAZPD II cohort. For this study we identified all patients on PD for greater than 90 days. Within that subset, all those with SLE as primary renal disease were matched with PD patients without SLE for comparison of clinical outcomes, namely: patient mortality, technique survival and time to first peritonitis, then were analyzed taking into account the presence of competing risks. RESULTS: Out of a total of 9907 patients, we identified 102 SLE patients incident in PD and with more than 90 days on PD. After matching the groups consisted of 92 patients with SLE and 340 matched controls. Mean age was 46.9 ± 16.8 years, 77.3% were females and 58.1% were Caucasians. After adjustments SLE sub-hazard distribution ratio for mortality was 1.06 (CI 95% 0.55-2.05), for technique failure was 1.01 (CI 95% 0.54-1.91) and for time to first peritonitis episode was 1.40 (CI 95% 0.92-2.11). The probability for occurrence of competing risks in all three outcomes was similar between groups. CONCLUSION: PD therapy was shown to be a safe and equally successful therapy for SLE patients compared to matched non-SLE patients.

Bag exchange in continuous ambulatory peritoneal dialysis without use of a face mask: experience of five years.

This article describes our five-year experience of continuous ambulatory peritoneal dialysis (CAPD) with bag exchanges performed without use of a face mask. The study took place in the renal unit at a university hospital. All patients admitted to the CAPD program from February 1995 to March 2000 were trained to perform bag exchanges without use of a face mask. Occurrence of peritonitis episodes was the outcome of interest. We evaluated 94 patients (52 women, 42 men) with a mean age of 48 +/- 21 years and a total follow-up of 50,502 patient-days. During that time, 79 episodes of peritonitis occurred in 46 patients, for a peritonitis rate of 0.57 episodes/year. The most frequently isolated micro-organisms were Staphylococcus epidermidis in 20 patients (25.3%) and S. aureus in 11 patients (13.9%). Renal transplantation was the major cause of drop-out [23 patients (43.4%)], followed by peritonitis [14 patients (26.4%)], death due to cardiovascular complications [9 patients (17.0%)], loss of ultrafiltration [2 patients (3.8%)], and other causes [5 patients (9.4%)]. The probability of being free of peritonitis at 12 months was 0.60, and at 60 months, 0.37. Peritonitis rates during the study period were not different from those reported by other centers, supporting the hypothesis that routine use of a face mask during CAPD bag exchange may be unnecessary.

Peritonitis prevention in CAPD: to mask or not?

OBJECTIVE: To assess the efficacy of wearing a face mask to prevent peritonitis during continuous ambulatory peritoneal dialysis (CAPD) bag exchange. SETTING: Renal unit at a university hospital. PATIENTS: Two groups of patients on CAPD were compared: those performing bag exchange with (n = 24) and those without a face mask (n = 40). OUTCOMES: Occurrence of first episode of peritonitis and total number of episodes. RESULTS: No difference was found between groups with respect to probability of developing the first episode of peritonitis (p = 0.757). Patients holding university degrees had evidence of protection, with borderline significance [relative risk (RR) 0.52; confidence interval (CI) 95%, 0.23 -1.18; p= 0.109]. Cox's proportional hazard regression analysis also demonstrated a significant protective factor for patients with university level education (RR 0.42; Cl 95%, 0.18 - 0.98; p = 0.04). Incidence of peritonitis was not significantly different between groups: with-mask group had 1.0 episode/year, and without-mask group had 0.94 episodes/year. Staphylococcus epidermidis was the most commonly identified agent. Staphylococcus aureus was found more frequently in the with-mask group (p = 0.003). Peritonitis due to Streptococcus viridans and Enterococci were detected only in the without-mask group. CONCLUSION: The current study suggests that routine use of face masks during CAPD bag exchanges may be unnecessary and could be discontinued.

Clinical and endocrine aspects of the oestrous cycle in donkeys (Equus asinus).

Oestrous behaviour and occurrence of ovulation was studied in 13 jenny asses (3-18 years) during a 15-month period. Teasing was performed daily and follicular growth, ovulation and changes of the genitalia were checked every other day by rectal palpation during dioestrus or the anovulatory season or daily during oestrus and when a follicle greater than or equal to 3 cm in diameter was present. Plasma oestrogens and progesterone levels were measured by radioimmunoassay (RIA). Of the 13 jennies, 6 showed a typical seasonal ovarian activity, 1 stopped cycling only at the end of the experiment, 2 ovulated regularly and 4 did not cycle. Mean (+/- s.d.) length of the anovulatory season in the 6 jennies with seasonal cyclic ovarian activity was 166.3 +/- 63.2 days (74-263 days). Irregular oestrous periods were detected during the anovulatory season of these jennies. Irregular signs of oestrus and follicular growth were detected in the 4 jennies which remained acyclic during the whole experiment. Mean (+/- s.d.) length of the ovulatory season was 197.8 +/- 63.4 days (102-291 days). Overall mean +/- s.d. lengths for the oestrous cycle and dioestrous and oestrous periods were 25.9 +/- 2.7 (n = 74), 18.2 +/- 2.3 (n = 70) and 7.9 +/- 2.5 (n = 79) days. Ovulatory oestrous periods tended to be longer at the start and end of the season than during the summer months. Dioestrous length was not affected by season.(ABSTRACT TRUNCATED AT 250 WORDS)