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1.
Pediatr Nephrol ; 36(1): 143-151, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32980942

RESUMO

BACKGROUND: In March 2020, COVID-19 infections began to rise exponentially in the USA, placing substantial burden on the healthcare system. As a result, there was a rapid change in transplant practices and policies, with cessation of most procedures. Our goal was to understand changes to pediatric kidney transplantation (KT) at the national level during the COVID-19 epidemic. METHODS: Using SRTR data, we examined changes in pediatric waitlist registration, waitlist removal or inactivation, and deceased donor and living donor (DDKT/LDKT) events during the start of the disease transmission in the USA compared with the same time the previous year. RESULTS: We saw an initial decrease in DDKT and LDKT by 47% and 82% compared with expected events and then a continual increase, with numbers reaching expected prepandemic levels by May 2020. In the early phase of the pandemic, waitlist inactivation and removals due to death or deteriorating condition rose above expected values by 152% and 189%, respectively. There was a statistically significant decrease in new waitlist additions (IRR 0.49 0.65 0.85) and LDKT (IRR 0.17 0.38 0.84) in states with high vs. low COVID activity. Transplant recipients during the pandemic were more likely to have received a DDKT, but had similar calculated panel-reactive antibody (cPRA) values, waitlist time, and cause of kidney failure as before the pandemic. CONCLUSIONS: The COVID-19 pandemic initially reduced access to kidney transplantation among pediatric patients in the USA but has not had a sustained effect.


Assuntos
Transplante de Rim/estatística & dados numéricos , Doadores Vivos/estatística & dados numéricos , Listas de Espera/mortalidade , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Pandemias , Sistema de Registros , Estados Unidos/epidemiologia , Adulto Jovem
2.
Transplant Proc ; 52(9): 2607-2613, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32773284

RESUMO

The concerns generated by coronavirus disease 2019 (COVID-19) pandemic are having profound impact on solid organ transplantation (SOT). Non-pharmaceutical interventions (NPI) are currently the only measures available to contain COVID-19 in the general population and in more vulnerable recipients of any organ transplant. In this cross-sectional case control study from a patient survey undertaken in 2 transplant centers (TxC) in the Kingdom of Saudi Arabia and Italy, we aimed to appraise awareness of the NPI implemented by respective these governments. We have also evaluated the impact of COVID-19 on our kidney transplant (KT) recipients and a control group of kidney living donors (KLD). In our series, there were zero cases of COVID-19 among 111 KT recipients and 70 KLD of the control group. Demography, transplant type, immunosuppression regimes, and, importantly, the different COVID-19 prevalence in the 2 regions of the TxC did not appear to influence incidence of COVID-19 in our KT recipients. The absence of COVID-19 cases in our series was unexpected. Our findings suggest that awareness of NPI is associated with a successful containment of COVID-19 in vulnerable, immunosuppressed KT recipients.


Assuntos
Betacoronavirus/imunologia , Infecções por Coronavirus/epidemiologia , Hospedeiro Imunocomprometido/imunologia , Transplante de Rim/efeitos adversos , Pneumonia Viral/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Adulto , Estudos de Casos e Controles , Infecções por Coronavirus/imunologia , Estudos Transversais , Feminino , Humanos , Incidência , Itália/epidemiologia , Doadores Vivos/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/imunologia , Complicações Pós-Operatórias/imunologia , Complicações Pós-Operatórias/virologia , Prevalência , Arábia Saudita/epidemiologia , Coleta de Tecidos e Órgãos/efeitos adversos , Obtenção de Tecidos e Órgãos/estatística & dados numéricos
3.
Transplantation ; 104(8): 1633-1643, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32732841

RESUMO

BACKGROUND: The cellular infiltrate in protocol liver biopsies (PB) following pediatric liver transplantation remains mostly uncharacterized, yet there is increasing concern about the role of inflammation and fibrosis in long-term liver allografts. We aimed to define cell types in PB and to analyze their relationship with donor-specific antibodies (DSA) and histological phenotype. METHODS: PB were performed at least 1 year after transplantation. We identified 4 phenotypes: normal, fibrosis, inflammation, inflammation with fibrosis. Cell types were counted after immunostaining for CD3, CD4, CD8, CD68, CD20, MUM1, and FoxP3. RESULTS: Forty-four patients underwent 1 PB between 2000 and 2015. Eleven percent (5/44) of PB displayed normal histology, 13.6% (6/44) fibrosis, 34.1% (15/44) inflammation, and 40.9% (18/44) inflammation and fibrosis. The main cell types in the portal tracts and lobules were CD3+ and CD68+ cells. Frequency of de novo DSA was 63% (27/44). The presence of CD8+ cells in the lobules was associated with fibrosis. Inflammation and fibrosis in PB were associated with the presence of circulating de novo DSA, number of de novo DSA, and C1q binding activity when compared to other phenotypes. CONCLUSIONS: T cells (CD3+) and macrophages (CD68+) were the most prevalent cell-types in PB. In the presence of inflammation, portal tracts were enriched in CD3+, CD20+ but displayed fewer CD68+. This coincided with the presence and number of de novo DSA. How these cellular and humoral actors interact is unclear, but peripheral DSA may be a marker of immune cellular activity in the seemingly quiescent allograft.


Assuntos
Doença Hepática Terminal/cirurgia , Rejeição de Enxerto/imunologia , Isoanticorpos/imunologia , Transplante de Fígado/efeitos adversos , Sistema Porta/imunologia , Adolescente , Adulto , Aloenxertos/irrigação sanguínea , Aloenxertos/imunologia , Aloenxertos/patologia , Biópsia , Criança , Pré-Escolar , Doença Hepática Terminal/diagnóstico , Doença Hepática Terminal/etiologia , Feminino , Fibrose , Seguimentos , Rejeição de Enxerto/patologia , Sobrevivência de Enxerto/imunologia , Antígenos HLA/imunologia , Teste de Histocompatibilidade/estatística & dados numéricos , Humanos , Imunidade Celular , Lactente , Isoanticorpos/análise , Fígado/irrigação sanguínea , Fígado/imunologia , Fígado/patologia , Doadores Vivos/estatística & dados numéricos , Macrófagos/imunologia , Masculino , Sistema Porta/citologia , Índice de Gravidade de Doença , Linfócitos T/imunologia , Transplantados/estatística & dados numéricos , Transplante Homólogo/efeitos adversos , Adulto Jovem
4.
Scand J Immunol ; 92(5): e12923, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32593197

RESUMO

Antibody-mediated rejections (AMR) in the absence of circulating anti-HLA-DSA have highlighted the role of non-HLA antibodies, particularly those directed against endothelial cells. Of these, MICA (major histocompatibility complex class I chain-related molecule A) antibodies are the most notable and important because of their potential in promoting graft rejections. Limited studies have focused on the impact of MICA donor-specific antibodies (DSA) on graft outcome as compared to those that are not donor-specific (NDSA). We evaluated pre- and post-transplant sera at POD 7, 30, 90, 180 and the time of biopsy from 206 consecutive primary live donor renal transplant recipients for anti-MICA and anti-HLA antibodies using single antigen bead assay on a Luminex platform. Recipients who developed MICA antibodies and their donors were phenotyped for MICA alleles. For the purpose of antibody analysis, patients were categorized into three major groups: biopsy-proven AMR, acute cellular rejection (ACR) and those with no rejection episodes (NRE). During the mean follow-up period of 17.37 ± 6.88 months, 16 of the 206 recipients developed AMR, while ACR was observed in only 13 cases. A quarter (25%) of the AMR cases had anti-MICA antibodies as compared to 7.7% of those experiencing ACR and 6.2% of the NRE group. Allelic typing revealed that all MICA Ab +ve AMR cases were due to the presence of donor-specific antibodies. MICA-DSA even in the absence of HLA-DSA was significantly associated with AMR but not with ACR when compared with the NRE group (P = <.01).


Assuntos
Anticorpos/imunologia , Antígenos HLA/imunologia , Antígenos de Histocompatibilidade Classe I/imunologia , Transplante de Rim/métodos , Doadores Vivos/estatística & dados numéricos , Adulto , Alelos , Anticorpos/sangue , Células Endoteliais/imunologia , Feminino , Rejeição de Enxerto/imunologia , Sobrevivência de Enxerto/imunologia , Antígenos HLA/genética , Antígenos de Histocompatibilidade Classe I/genética , Teste de Histocompatibilidade , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Transplante Homólogo , Adulto Jovem
5.
Eur J Epidemiol ; 35(7): 699-707, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32440788

RESUMO

BACKGROUND: Live donor nephrectomy is a safe procedure. However, long-term donor prognosis is debated, necessitating high-quality studies. METHODS: A follow-up study of 761 living kidney donors was conducted, who visited the outpatient clinic and were propensity score matched and compared to 1522 non-donors from population-based cohort studies. Primary outcome was kidney function. Secondary outcomes were BMI (kg/m2), incidences of hypertension, diabetes, cardiovascular events, cardiovascular and overall mortality, and quality of life. RESULTS: Median follow-up after donation was 8.0 years. Donors had an increase in serum creatinine of 26 µmol/l (95% CI 24-28), a decrease in eGFR of 27 ml/min/1.73 m2 (95% CI - 29 to - 26), and an eGFR decline of 32% (95% CI 30-33) as compared to non-donors. There was no difference in outcomes between the groups for ESRD, microalbuminuria, BMI, incidence of diabetes or cardiovascular events, and mortality. A lower risk of new-onset hypertension (OR 0.45, 95% CI 0.33-0.62) was found among donors. The EQ-5D health-related scores were higher among donors, whereas the SF-12 physical and mental component scores were lower. CONCLUSION: Loss of kidney mass after live donation does not translate into negative long-term outcomes in terms of morbidity and mortality compared to non-donors. TRIAL REGISTRATION: Dutch Trial Register NTR3795.


Assuntos
Transplante de Rim/efeitos adversos , Rim/fisiologia , Doadores Vivos/psicologia , Nefrectomia/efeitos adversos , Qualidade de Vida/psicologia , Estudos de Casos e Controles , Creatinina/sangue , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/etiologia , Feminino , Taxa de Filtração Glomerular , Humanos , Hipertensão/epidemiologia , Hipertensão/etiologia , Incidência , Testes de Função Renal , Doadores Vivos/estatística & dados numéricos , Masculino , Nefrectomia/psicologia , Vigilância da População , Complicações Pós-Operatórias/epidemiologia , Pontuação de Propensão , Resultado do Tratamento
6.
Transplant Proc ; 52(6): 1665-1670, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32417037

RESUMO

OBJECTIVE: To study the trend among Indian women living kidney donation over the past 18 years and see if a gender bias still exists as described in literature before. METHODS: This is a retrospective, single-center, observational cohort study with data collected from the medical records department of all living donor kidney transplants between January 2001 to December 2018, which were categorized into 2 groups of 9 years each for comparison using categorical variables in form of number, percentage, χ2 test, and Pearson correlation coefficient. RESULTS: A total of 557 kidney transplants were analyzed, with women having 78.5% higher incidence of donation (P < .001). Among them, parents (72.20% mothers), spouses (87.20% wives), siblings (47.50% sisters), and children (44.44% daughters) were the major participants. Further analysis revealed wife donation reduced from 92.3% to 85.6% (P = .41) and mother donation reduced from 72.5% to 71.7% (P = .91), whereas sister donation increased from 28.5% to 51.5% (P = .14) and daughter donation increased from 0% to 44.4% during the 18-year period. Also, female to male donation decreased from 63.8% to 51.6% (P = .02) during the same period. Thus, the overall percentage of female donation is decreasing (73.9% to 61.4%, P = .01), and a significant negative correlation with time was observed in this study (correlation coefficient, r = -0.55, P = .017). CONCLUSIONS: A lot has changed over the past 18 years, with more male kidney donors now coming forward. Larger prospective studies are required to understand the diverse reason for this sex discrepancy.


Assuntos
Transplante de Rim , Doadores Vivos/estatística & dados numéricos , Sexismo , Adulto , Estudos de Coortes , Feminino , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos
7.
J Surg Res ; 253: 41-52, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32320896

RESUMO

BACKGROUND: To assess the impact of living liver donation (LD) in a diverse and aging population up to 20 y after donation, particularly with regard to medical, financial, psychosocial, and overall health-related quality of life (HRQOL). METHODS: Patients undergoing LD between 1999 and 2009 were recruited to respond to the Short-Form 36 and a novel Donor Quality of Life Survey at two time points (2010 and 2018). RESULTS: Sixty-eight living liver donors (LLDs) completed validated surveys, with a mean follow-up of 11.5 ± 5.1 y. Per Donor Quality of Life Survey data, physical activity or strength was not impacted by LD in most patients. All respondents returned to school or employment, and 82.4% reported that LD had no impact on school or work performance. LD did not impact health insurability in 95.6% of donors, and only one patient experienced difficulty obtaining life insurance. Overall, 97.1% of respondents did not regret LD. Short-Form 36 survey-measured outcomes were similar between LLDs and the general U.S. POPULATION: LLDs who responded in both 2010 and 2018 were followed for an overall average of 15.4 ± 2.4 y and HRQOL outcomes in these donors also remained statistically equivalent to U.S. population norms. CONCLUSIONS: This study represents the longest postdonation follow-up and offers unique insight related to HRQOL in a highly diverse patient population. Although LLDs continue to maintain excellent HRQOL outcomes up to 20 y after donation, continued lifetime follow-up is required to accurately provide young, healthy potential donors with an accurate description of the risks that they may incur on aging.


Assuntos
Emoções , Hepatectomia/efeitos adversos , Doadores Vivos/psicologia , Qualidade de Vida , Obtenção de Tecidos e Órgãos , Adolescente , Adulto , Emprego/economia , Emprego/psicologia , Emprego/estatística & dados numéricos , Feminino , Seguimentos , Hepatectomia/psicologia , Humanos , Cobertura do Seguro/economia , Cobertura do Seguro/estatística & dados numéricos , Transplante de Fígado , Doadores Vivos/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários/estatística & dados numéricos , Fatores de Tempo , Adulto Jovem
8.
PLoS One ; 15(3): e0230840, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32226025

RESUMO

BACKGROUND & AIMS: Whether living liver donors have a higher risk of biliary tract disease compared with non-donors remains unknown. METHODS: Data were collected from the Taiwan Longitudinal Health Insurance Database for the 2003-2011 period. The study cohort comprised 1,446 patients aged ≥ 18 years who had served as living liver donors. The primary outcome was the incidence of biliary tract disease. Cox proportional hazards modeling was used to determine the hazard ratios. RESULTS: The incidence density rate of biliary tract disease was 13.9-fold higher in the liver donor (LD) cohort than in the non-LD cohort (10.2 vs. 0.71 per 1,000 person-years), with an adjusted hazard ratio (HR) of 14.2 (95% confidence interval [CI] = 7.73-26.1). Stratified by comorbidity, the relative risk of biliary tract disease was higher in the LD cohort than in the non-LD cohort for both patients with or without comorbidity. The incidence density rate of biliary tract disease was significantly higher in the first 3 years (13.5 per 1,000 person-years in the LD cohort). The highest adjusted HR of biliary tract disease for LD patients compared with the non-LD cohort was 22.4 (95% CI = 10.8-46.1) in the follow-up ≤ 3 years. CONCLUSION: Living liver donors had a higher risk of biliary tract disease compared with non-donors.


Assuntos
Doenças Biliares/epidemiologia , Doadores Vivos/estatística & dados numéricos , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Risco
9.
Transplantation ; 104(3): 583-590, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32106202

RESUMO

BACKGROUND: Recipients of kidneys from living donors who subsequently develop end-stage renal disease (ESRD) also have higher graft failure, suggesting the 2 donor kidneys share risk factors that could inform recipient outcomes. Given that donor ESRD is rare, an earlier and more common postdonation outcome could serve as a surrogate to individualize counseling and management for recipients. Hypertension is a frequent event before donor ESRD; thus, early postdonation hypertension might indicate higher risk of graft failure. METHODS: We studied Scientific Registry of Transplant Recipients data to quantify the association between early postdonation hypertension and recipient graft failure using propensity score-weighted Cox proportional hazards regression. We also examined the association between postdonation systolic blood pressure and graft failure. RESULTS: Of 37 901 recipients, 2.4% had a donor who developed hypertension within 2 years postdonation. Controlling for donor and recipient characteristics, recipients whose donors developed hypertension had no higher risk for graft failure (adjusted hazard ratio [aHR] 1.03, 95% confidence interval [CI] 0.85-1.25, P = 0.72). This was consistent among subgroups of recipients at higher risk for adverse outcomes due to hyperfiltration: African American recipients (aHR 1.10, 95% CI 0.70-1.73, P = 0.68) and those with ESRD caused by hypertension (aHR 1.10, 95% CI 0.65-1.85, P = 0.73) or diabetes (aHR 0.80, 95% CI 0.56-1.13, P = 0.20). However, graft failure was associated with postdonation systolic blood pressure (per 10 mm Hg, aHR 1.05, 95% CI 1.03-1.08, P < 0.001). CONCLUSIONS: Although postdonation systolic blood pressure is associated with graft failure, the reported diagnosis of hypertension as determined by the requirement for blood pressure treatment early postdonation did not portend a higher risk of recipient graft failure in the same way as eventual postdonation ESRD.


Assuntos
Rejeição de Enxerto/epidemiologia , Hipertensão/epidemiologia , Transplante de Rim/efeitos adversos , Nefrectomia/efeitos adversos , Coleta de Tecidos e Órgãos/efeitos adversos , Adulto , Anti-Hipertensivos/uso terapêutico , Feminino , Seguimentos , Rejeição de Enxerto/etiologia , Sobrevivência de Enxerto , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/etiologia , Incidência , Rim , Falência Renal Crônica/cirurgia , Doadores Vivos/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Sistema de Registros/estatística & dados numéricos , Medição de Risco , Fatores de Risco , Transplantados/estatística & dados numéricos
10.
Transplantation ; 104(3): e65-e74, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31895342

RESUMO

BACKGROUND: Understanding the outcomes and risks for live kidney donors (LD) is increasingly important; this study investigated all-cause mortality and morbidity outcomes of LD compared with a healthy cohort. METHODS: Live donor dataset was obtained from the UK Transplant Registry and a comparator nondonor cohort selected from The Health Improvement Network (THIN) database, a UK primary healthcare database. All LD from January 1, 2001, to December 31, 2013, were included, with follow-up until December 31, 2016. RESULTS: There were 9750 LD and 19 071 THIN participants. Median follow-up (interquartile range) for LD was 8.4 (6.0-11.3) years and for THIN was 5.4 (2.6-8.5) years. In up to 15 years, follow-up end-stage renal disease was observed in 1 LD versus 7 THIN (P = 0.280). Nine LD had estimated glomerular filtration rate of <30 mL/min/1.73 m versus 43 in THIN (P = 0.012), but no statistically significant difference in adjusted logistic regression analyses. Risk of diabetes mellitus, depression, and cardiovascular disease was significantly higher for THIN cohort in adjusted analyses. The risk of hypertension was higher for LD at 5 years but was not significantly different in fully adjusted analyses at 10 years. There were 68 deaths in LD and 485 in THIN over the follow-up period, with significant difference in mortality favoring LD (P < 0.001). CONCLUSIONS: The medium-term morbidity and mortality outcomes of live donors in comparison with a healthy cohort suggest that live donation is not associated with excess mortality, end-stage renal disease, or morbidity, in at least 10 years follow-up.


Assuntos
Falência Renal Crônica/epidemiologia , Doadores Vivos/estatística & dados numéricos , Nefrectomia/efeitos adversos , Coleta de Tecidos e Órgãos/efeitos adversos , Adolescente , Adulto , Causas de Morte , Conjuntos de Dados como Assunto , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Falência Renal Crônica/etiologia , Transplante de Rim/métodos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Reino Unido/epidemiologia , Adulto Jovem
11.
Curr Opin Organ Transplant ; 25(1): 74-79, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31833966

RESUMO

PURPOSE OF REVIEW: Although the first successful kidney transplantation 65 years ago was performed with a living donor kidney, the number of living donor kidney transplantations has increased especially during the last 2 decades. The enlargement of living donor programs was made possible by new modes of living donation and by expansion of the living donor pool. At the same time, the long-term risks of kidney donation have been better delineated. In this review, the latest developments on these topics are summarized. RECENT FINDINGS: While the results of ABO-incompatible living kidney transplantation are superior to those of deceased donor transplantation, recent meta-analyses show a reduced patient and graft survival as compared with ABO compatible transplantation as well as increased risk of severe infection and bleeding. Kidney paired donation programs can be extended by including compatible couples and by advanced donation, although the latter raises ethical concerns. Living donors appear to have a higher risk of end-stage renal disease and this is especially true for obese donors and probably also for black donors with an APOL1 high-risk genotype. The importance of psychosocial outcomes after living kidney donation is increasingly recognized. SUMMARY: Living donor kidney transplantation remains the optimal treatment option for patients with end-stage renal disease. To increase the donor pool, a well developed paired kidney donation program and sufficient reimbursement of costs associated with donation are essential ingredients. Other ways of expanding the donor pool, such as ABO-incompatible transplantation, use of higher risk donors, providing donors with financial incentives and advanced donation are associated with medical, ethical and logistical complications. There should be a careful selection and follow-up of living kidney donors with attention for medical consequences as well as for psychosocial outcomes.


Assuntos
Transplante de Rim/métodos , Doadores Vivos/estatística & dados numéricos , Obtenção de Tecidos e Órgãos/métodos , Humanos
12.
Curr Opin Organ Transplant ; 25(1): 47-51, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31834006

RESUMO

PURPOSE OF REVIEW: In the United States, most of the liver allografts come from deceased donors, and our current liver recipient selection process is heavily centered on the ethical principle of utility to maximize the net benefit to the liver recipient community as a group rather than individuals due to the organ scarcity. Although living donor liver transplantation contributes less than 5% of total liver transplant in the United States, these living donor recipients are being subjected to the same selection process designed to benefit the group as a whole rather than the individuals. We would like to examine if these recipients who have living donors should be subjected to the same selection process. RECENT FINDINGS: There are several disease processes where liver transplantation is the only curative option, and recent studies have shown clear survival benefits with liver transplantation. SUMMARY: For those who have living donors, different selection criteria based on their specific disease, not based on the principle of utilization should be used to evaluate their candidacy.


Assuntos
Seleção do Doador/métodos , Transplante de Fígado/métodos , Doadores Vivos/estatística & dados numéricos , Seleção de Pacientes/ética , Humanos , Hepatopatias
13.
Transpl Infect Dis ; 22(1): e13212, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31715063

RESUMO

OBJECTIVES: Mycobacterium tuberculosis DNA has been detected in multiple organs in people without active tuberculosis or a history of tuberculosis. Molecular testing for metabolic activity has suggested that M tuberculosis DNA represents viable bacilli. Whether transplanted organs with M tuberculosis DNA can result in tuberculosis in recipients has not been assessed. METHODS: Biopsies obtained at the time of living donor liver transplantation were tested for the presence of M tuberculosis DNA using in situ PCR. The cohort of recipients was longitudinally followed for the development of tuberculosis. RESULTS: Living donor liver transplantation was performed for 270 patients. Mean age was 33 years (median: 41 years, range: 1-80 years). Recipients were followed for a mean of 68 months (median: 72 months, range: 1-138 months) after transplantation. Mycobacterium tuberculosis DNA was detected in 25 of 155 donated livers (16%) with liver biopsies available for testing. None of the recipients of these livers received tuberculosis chemoprophylaxis and only one (4%) developed tuberculosis 15 months after transplantation. Among the entire cohort of 270 patients, post-transplant tuberculosis was diagnosed in four patients (1.48%) at an incidence rate of 2.61 cases per 1000 transplant-years. No factors associated with developing tuberculosis were identified, including positive M tuberculosis DNA in transplanted livers. CONCLUSIONS: Mycobacterium tuberculosis DNA in living donor transplanted livers did not result in tuberculosis despite post-transplant immunosuppression.


Assuntos
DNA Bacteriano/análise , Transplante de Fígado/efeitos adversos , Fígado/microbiologia , Doadores Vivos/estatística & dados numéricos , Tuberculose/transmissão , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Fígado/patologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis , Estudos Retrospectivos , Adulto Jovem
14.
Nephrol Dial Transplant ; 35(6): 1017-1026, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-30403810

RESUMO

BACKGROUND: High glomerular filtration rate (GFR) is often used as a surrogate for single-nephron hyperfiltration. Our objective was to determine the definition for high GFR that best reflects clinical and structural characteristics of hyperfiltration. METHODS: We studied living kidney donors at the Mayo Clinic and Cleveland Clinic. Potential donors underwent evaluations that included measured GFR (mGFR) by iothalamate clearance and estimated GFR (eGFR) by the serum creatinine-based Chronic Kidney Disease-Epidemiology collaboration (CKD-EPI) equation. High GFR was defined by the 95th percentile for each method (mGFR or eGFR) using either overall or age-specific thresholds. High mGFR was defined as both corrected and uncorrected for body surface area. The association of high GFR by each definition with clinical characteristics and radiologic findings (kidney volume) was assessed. In the subset that donated, the association of high GFR with kidney biopsy findings (nephron number and glomerular volume) and single-nephron GFR was assessed. RESULTS: We studied 3317 potential donors, including 2125 actual donors. The overall 95th percentile for corrected mGFR was 134 mL/min/1.73 m2 and for eGFR was 118 mL/min/1.73 m2. The age-based threshold for uncorrected mGFR was 198 mL/min - 0.943×Age, for corrected mGFR it was 164 mL/min/1.73 m2 - 0.730×Age and for eGFR it was 146 mL/min/1.73 m2 - 0.813×Age. High age-based uncorrected mGFR had the strongest associations with higher single-nephron GFR, larger glomerular volume, larger kidney volume, male gender, higher body mass index and higher 24-h urine albumin, but also had the strongest association with high nephron number. A high age-height-gender-based uncorrected mGFR definition performed almost as well but had a weaker association with nephron number and did not associate with male gender. CONCLUSIONS: High age-based uncorrected mGFR showed the most consistent associations reflective of hyperfiltration. However, high age-based uncorrected mGFR has limited clinical utility because it does not distinguish between hyperfiltration and high nephron number.


Assuntos
Taxa de Filtração Glomerular , Glomérulos Renais/fisiopatologia , Doadores Vivos/estatística & dados numéricos , Insuficiência Renal Crônica/epidemiologia , Adolescente , Adulto , Idoso , Índice de Massa Corporal , Superfície Corporal , Creatinina/sangue , Feminino , Humanos , Incidência , Testes de Função Renal/métodos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
15.
Transplantation ; 104(5): 1033-1040, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31415037

RESUMO

BACKGROUND: Donor factors can influence decision making for organ utilization for potential kidney transplant candidates. Prior studies exploring the effect of donor-recipient sex matching on kidney transplant outcomes have reported heterogenous and conflicting results. The aim of this contemporary population-cohort analysis was to explore the effect of donor-recipient sex matching on kidney transplant outcomes in the United Kingdom. METHODS: In this retrospective, observational study, we analyzed all patients receiving kidney-alone transplants between 2003 and 2018 using UK Transplant Registry data. Stratified by recipient sex, outcomes were compared between male and female donors with univariable/multivariable analyses. RESULTS: Data were analyzed for 25 140 recipients. Of these, 13 414 (53.4%) of kidneys were from male donors and 15 690 (62.4%) of recipients were male. The odds of initial graft dysfunction (delayed graft function/primary nonfunction) were significantly lower for female donor kidneys transplanted into both male (adjusted odds ratio = 0.89, 95% confidence interval [CI] = 0.80-0.98, P = 0.019) and female (adjusted odds ratio = 0.81, 95% CI = 0.71-0.93, P = 0.003) recipients. Male recipients of female donor kidneys had creatinine levels at 1 year that were 6.3% higher (95% CI = 4.8%-7.7%, P < 0.001) than male recipients of male donor kidneys, with a similar sex difference of 4.1% (95% CI = 2.1%-6.1%, P < 0.001) observed within female recipients. However, neither patient nor graft survival was found to differ significantly by donor sex on either univariable or multivariable analysis. CONCLUSIONS: Our data provide contemporary data on sex mismatch for recipient counseling and reassurance with regards to equivalent long-term clinical outcomes based upon donor sex.


Assuntos
Tomada de Decisões , Rejeição de Enxerto/epidemiologia , Transplante de Rim/métodos , Doadores Vivos/estatística & dados numéricos , Vigilância da População/métodos , Sistema de Registros , Transplantados/estatística & dados numéricos , Adulto , Feminino , Seguimentos , Sobrevivência de Enxerto , Humanos , Incidência , Falência Renal Crônica/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Distribuição por Sexo , Fatores Sexuais , Reino Unido/epidemiologia , Adulto Jovem
16.
Transplantation ; 104(2): 285-292, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31107823

RESUMO

BACKGROUND: Alcoholic liver disease (ALD) accounts for 15%-30% of transplants performed in the United States and Europe; however, the data on living donor liver transplantation (LDLT) for ALD remain sparse. The purpose of this study was to examine the outcomes following LDLT for ALD using data from the adult-to-adult living donor liver transplantation (A2ALL) study, which represents the largest Western experience with adult-to-adult LDLT. METHODS: A retrospective review of A2ALL data collected between 1998 and 2014 was performed. Patients were excluded if they received a deceased donor liver transplant. Demographic data, postoperative outcomes and complications, graft and patient survival, and predictors of graft and patient survival were assessed. RESULTS: Of the 1065 patients who underwent LDLT during the study time period, 168 (15.8%) were transplanted for a diagnosis of ALD. Comparing patients who underwent transplant for ALD with those who were transplanted for other etiologies of liver disease, there was no significant difference in graft survival at 1 (88% versus 84%), 5 (76% versus 74%), or 10 years following transplant (55% versus 61%, P = 0.29). Similarly, there was no difference in patient survival at 1 (94% versus 91%), 5 (83% versus 79%), or 10 years following transplant (61% versus 66%, P = 0.32). CONCLUSIONS: LDLT for ALD results in excellent 1-, 5-, and 10-year graft and patient survival. Patients with ALD and impaired renal function have a higher risk of graft loss and death. These findings support the notion that early LDLT for patients with ALD may help optimize outcomes.


Assuntos
Hepatopatias Alcoólicas/complicações , Falência Hepática/cirurgia , Transplante de Fígado/métodos , Doadores Vivos/estatística & dados numéricos , Medição de Risco/métodos , Adulto , Seguimentos , Sobrevivência de Enxerto , Humanos , Incidência , Hepatopatias Alcoólicas/cirurgia , Falência Hepática/epidemiologia , Falência Hepática/etiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Fatores de Tempo , Estados Unidos/epidemiologia
17.
Am J Kidney Dis ; 75(6): 919-925, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31866225

RESUMO

RATIONALE & OBJECTIVE: Living kidney donors may have a higher risk for death and kidney failure. This study aimed to investigate the long-term mortality experience of living kidney donors compared with members of the general public in Korea who underwent voluntary health examinations. STUDY DESIGN: Cohort study. SETTING & PARTICIPANTS: We first calculated standardized mortality ratios for 1,292 Korean living kidney donors who underwent donor nephrectomy between 1982 and 2016 and 72,286 individuals who underwent voluntary health examinations between 1995 and 2016. Next we compared survival between the 1,292 living kidney donors and a subgroup of the health examination population (n=33,805) who had no evident contraindications to living kidney donation at the time of their examinations. Last, a matched comparator group was created from the health examination population without apparent contraindication to donation by matching 4,387 of them to donors (n=1,237) on age, sex, body mass index, estimated glomerular filtration rate, urine dipstick albumin excretion, previously diagnosed hypertension and diabetes, and era. EXPOSURES: Donor nephrectomy. OUTCOMES: All-cause mortality and other clinical outcomes after kidney donation. ANALYTICAL APPROACH: First, standardized mortality ratios were calculated separately for living kidney donors and the health examination population standardized to the general population. Second, we used Cox regression analysis to compare mortality between living kidney donors versus the subgroup of the health examination population without evident donation contraindications. Third, we used Cox regression analysis to compare mortality between living kidney donors and matched comparators from the health examination population without apparent contraindication to donation. RESULTS: The living kidney donors and health examination population had excellent survival rates compared with the general population. 52 (4.0%) of 1,292 kidney donors died during a mean follow-up of 12.3±8.1 years and 1,072 (3.2%) of 33,805 in the health examiner subgroup without donation contraindications died during a mean follow-up of 11.4±6.1 years. Donor nephrectomy did not elevate the hazard for mortality after multivariable adjustment in kidney donors and the 33,805 comparators (adjusted HR, 1.01; 95% CI, 0.71-1.44; P=0.9). Moreover, living donors showed a similar mortality rate compared with the group of matched healthy comparators. LIMITATIONS: Donors from a single transplantation center. Residual confounding owing to the observational study design. CONCLUSIONS: Kidney donors experienced long-term rates of death comparable to nondonor comparators with similar health status.


Assuntos
Falência Renal Crônica/cirurgia , Transplante de Rim , Doadores Vivos/estatística & dados numéricos , Efeitos Adversos de Longa Duração , Nefrectomia/mortalidade , Adulto , Feminino , Taxa de Filtração Glomerular , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/etiologia , Transplante de Rim/métodos , Transplante de Rim/estatística & dados numéricos , Efeitos Adversos de Longa Duração/diagnóstico , Efeitos Adversos de Longa Duração/etiologia , Efeitos Adversos de Longa Duração/mortalidade , Masculino , Nefrectomia/métodos , Nefrectomia/estatística & dados numéricos , Avaliação de Processos e Resultados em Cuidados de Saúde , República da Coreia/epidemiologia
18.
Rev Peru Med Exp Salud Publica ; 37(4): 733-738, 2020.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-33566916

RESUMO

In order to describe the early functional and morphological changes in the remnant kidney of living donors, a retrospective study was carried out at the Cayetano Heredia Hospital. Data from 55 individuals was included. Clinical and demographic data were obtained from the clinical records, as well as data for creatinine clearance, proteinuria, blood pressure and renal dimensions at 1, 2, 3, 6 and 12 months after kidney donation. The mean age was 40.88 (±9.84) years; 80% were women and the mean body mass index was 25.68 (±3.5) kg/m2. Linear and quadratic models were used to study physiological and morphological variables. During the follow-up time, glomerular filtration rate, proteinuria, diastolic blood pressure, and kidney length showed significant changes (p < 0.05).


Assuntos
Transplante de Rim , Rim , Doadores Vivos , Adulto , Feminino , Seguimentos , Humanos , Rim/anatomia & histologia , Rim/fisiologia , Doadores Vivos/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
19.
Clin Transplant ; 33(12): e13753, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31692105

RESUMO

BACKGROUND: Bloodstream infection (BSI) is a life-threatening complication after living donor liver transplantation (LDLT). We aimed to explore the incidence and predisposing factors of BSI at our institution. METHODS: We conducted a retrospective cohort analysis on all consecutive adults with BSI within 6 months after LDLT performed between 2005 and 2016. For antimicrobial prophylaxis, ampicillin/sulbactam, cefotaxime, and micafungin were administered. From 2011, methicillin-resistant Staphylococcus aureus (MRSA) carriers were decolonized using mupirocin ointment and chlorhexidine gluconate soap. Risk factors for BSI were identified by uni- and multivariate logistic regression. RESULTS: Of a total of 106 LDLTs, 42 recipients (40%) suffered BSI. The BSI group demonstrated significantly higher in-hospital mortality rates compared with the non-BSI group (24% vs. 7%, P = .01). We identified MRSA carrier (odds ratio [OR], 19.1; P < .001), ABO incompatibility (OR, 2.9; P = .03), and estimated glomerular filtration rate <30 mL/min/1.73m2 (OR, 15.8; P = .02) as independent risk factors for BSI. Decolonization treatment for MRSA carriers did not reduce the incidence of all-cause BSI but reduced the frequency of BSI caused by MRSA. CONCLUSION: To our knowledge, for the first time, MRSA carriers were revealed to be highly vulnerable to BSI after LDLT.


Assuntos
Bacteriemia/epidemiologia , Portador Sadio/epidemiologia , Infecção Hospitalar/epidemiologia , Transplante de Fígado/efeitos adversos , Doadores Vivos/estatística & dados numéricos , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/epidemiologia , Idoso , Bacteriemia/microbiologia , Portador Sadio/microbiologia , Infecção Hospitalar/microbiologia , Feminino , Seguimentos , Humanos , Incidência , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Infecções Estafilocócicas/microbiologia
20.
BMC Health Serv Res ; 19(1): 755, 2019 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-31655578

RESUMO

BACKGROUND: No studies using a valid, standardized method to measure post-donation satisfaction levels among living kidney donors (LKDs) have been published. METHODS: Donor satisfaction levels were measured using the Japanese version of the Client Satisfaction Questionnaire-8 (CSQ-8), a validated, self-report questionnaire. To identify factors related to post-donation satisfaction levels, we compared donors' sociodemographic and psychological characteristics and health-related quality of life (HRQoL), using the Short Form-36 Health Survey (SF-36), as well as recipients' clinical characteristics and SF-36 scores between donors with and without low satisfaction. In addition, donors' perceptions of the donation results and transplant procedure were assessed using measures that we developed. RESULTS: The mean (standard deviation [SD]) CSQ-8 score for the 195 participants was 26.9 (3.4). Twenty-nine (14.9%) respondents with total scores < 1 SD below the mean CSQ-8 score were placed into the low satisfaction group. Multiple logistic regression analysis demonstrated that lower perceptions of receiving adequate information prior to transplantation (odds ratio [OR] = 0.17; 95% confidence interval [CI] = 0.079-0.379; p < 0.001), lower optimism according to the Life Orientation Test (OR = 1.24; 95% CI = 1.045-1.470; p = 0.014), and increased serum creatinine levels in the paired recipient (OR = 0.05; 95% CI = 0.250-1.011; p = 0.054) independently increased the odds of having less satisfaction with donation. CONCLUSIONS: Our findings suggest that careful pre-donation education and more detailed informed consent may be needed, especially in LKDs with low constitutional optimism.


Assuntos
Transplante de Rim , Doadores Vivos/psicologia , Satisfação Pessoal , Idoso , Feminino , Humanos , Japão , Doadores Vivos/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
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